Case Report
Report of Avian-Induced Ocular (R) Egret
Timothy T You1*, Dina Aluzri1, Daniel Youn1, Laura Howard2, George Garcia2, Lisa Garbutt3 and Dan B Tran3
1Orange County Retina Group, USA
2Ophthalmology Institute of Orange County, USA
3Coastal Vision, USA
*Corresponding author: Timothy T You, Orange County Retina Group, 1200 North Tustin Ave, Suite 140, Santa Ana, CA 92705, USA
Published: 10 Oct, 2016
Cite this article as: Aluzri D, You TT, Youn D, Howard L,
Garcia G, Garbutt L, et al. Report of
Avian-Induced Ocular (R) Egret. Ann
Clin Case Rep. 2016; 1: 1152.
Abstarct
Purpose: To report a case of a Great Egret attack causing a ruptured globe.
Method: Case report
Results: A 37-year-old male developed vision loss after being attacked by a Great Egret. He had
Hand motions visual acuity initially. After four ocular surgical operations including a retinal
detachment repair, the patient’s vision improved to 20/80 vision.
Conclusion: Avian related ocular injuries to humans are rare. This is the first report of a Great Egret
causing a globe rupture. Recognition and coordinated surgical care can result in rehabilitated vision
to the injured eye.
Keywords: Great egret; Ruptured globe; Retina; Detachment; Lens; B-scan; Vitrectomy; Lensectomy; Cornea; Keratoplasty
Case Presentation
A 37-year-old male developed vision loss and severe pain in the left eye after being attacked by
a Great Egret (Figure 1) at an urban park. The family history was negative for eye diseases, but the
patient has a history of mental health disorders, including bipolar disorder and Attention Deficit
Hyperactivity Disorder for which he was taking Wellbutrin 100 mg and Paxil 20 mg. The patient was
examined that day by a comprehensive ophthalmologist (LH), who diagnosed a ruptured globe. The
visual acuity was 20/25-1 in the unaffected right eye and “hand motions” at two feet in the left eye. He
had a 10mm, full-thickness, stellate corneal laceration extending from the limbus at the 10 o’clock
across the central cornea to 3 ‘o’clock. There was superior iridodialysis and prolapsed of uveal tissue
through the corneal wound. He underwent immediate surgical repair for primary closure of the
ruptured globe that same day by (LH).
Postoperatively, the patient remained at “hand motions” in the left eye. The pupil was irregular
with traumatic superior aniridia (Figure 2). The corneal sutures were intact, and the anterior
chamber was formed. The pressure in the left eye was 14 mmHg by tonometry. The fundus view was
limited due to vitreous hemorrhage.
The patient was referred to a retina specialist (TY) for further management. A B-scan ultrasound
revealed a temporal choroidal detachment and a partially subluxated, cataractous lens. The
patient had a dense vitreous hemorrhage. A pars plana vitrectomy was performed five weeksafter partialreduction of the large choroidal detachment. A lensectomy
was also performed using a fragmatome because of the subluxated
cataractous lens.
After the vitrectomy, the visual acuity improved from “hand
motions” to “counting fingersat two feet”. However, the patient
developed a retinal detachment over the next month. A B-scan
(Figure 3 and 4) showed a retinal detachment necessitating a
vitrectomy retinal detachment repair, membrane peel for proliferative
vitreoretinopathy, gas tamponade, and endolaser photocoagulation.
The retina remained attached after the second vitrectomy repair;
however, he developed progressive corneal scarring.
The patient was subsequently referred to a corneal specialist (LG)
for further management. Because of the dense axial cornea scar and
aphakia, a penetrating keratoplasty and a secondary IOL placement
were performed (LG and DT). The patient had a corneal transplant
and Alcon MA60AC +22.5 IOL diopter fixation on the sclera using
the glue fixation. The haptics were protected through a scleral tunnel
performed open sky with the penetrating keratoplasty.
At his most recent examination, nine months after the corneal
transplant and secondary intraocular lens implant surgery, the vision
in the left eye improved. The visual acuity measured 20/200 with a
pinhole improvement to 20/80. The patient reported doing well with
stable vision.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Discussion
The Great Egret, also known as Ardea alba, is a large, slender,
white heron with a long and sharp yellow bill (Figure 4). Temperate
southern California attracts migratory Great Egrets during the winter
time [3]. The patient was attacked at a small urban park with a lake in
Orange, California. The bird was feeding at the lake when disturbed
by the patient, which caused a defense responseby the bird.Great Egrets are known to defend their feeding sites or youngwith jabbing attacks with their bills [1,2].
Despite being popularized in fictional movies such as “The Birds”
[4] avian-relatedocular injuries to humans are unusual. An ostrich
kicked a human in the face causing severe blunt trauma to the eye
[5]. A sparrow had amid-flight collision into a person’s eye causing a
central corneal perforating injury and a flat anterior chamber [6]. A
mynah bird attack caused a true pecking injury leaving a human with
a beak-shaped, full-thickness corneal laceration and total aniridia in
the eye [7]. This case is the first report of a egret peck causing a fullthickness
laceration of the globe. Ophthalmologists should be aware
of this extraordinarymechanism of avian injury related to nesting
behavior. Immediate recognition and coordinated surgical care can
result in rehabilitated vision to the injured eye.
References
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- Chisholm D. Showy snowy and great egrets! Photographic society of America Journal. 2001: 32.
- Mccrimmon DJ Ogden, GT Bancroft. Great Egret (Ardea alba). In The Birds of North America. 570 (A. Poole, ed.). New York: The Birds of North America Online; 2011.
- The Birds. Dir. Alfred Hitchcock. Turner Classic Movies. 1963.
- LM Levitz, TR Carmichael, M Nissenbaum. Severe ocular trauma caused by an ostrich. Br J Ophthalmol. 2004; 88: 591.
- JRO Collin. Ocular Perforating Injury Caused by a Sparrow. Br Med J. 1975; 3: 520-521.
- Young AL, LL Cheng, SK Rao, DS Lam. Corneal laceration with total but isolated aniridia caused by a pecking injury. J Cataract Refract Surg. 2000; 26: 1419-1421.