as an occupation or past - time , fishing is widely practiced around the world .
however , surprisingly , despite such extensive prevalence , injuries to the eyes from fish - hooks are rarely reported .
a literature search provided less than a dozen cases of fish - hook injuries to the ocular structures .
so far , there has been no reported case of actually using the cut - it - out technique for fish - hook removal , even though , it is reported in the literature as an option .
thus , this case report focuses on a rather uncommon , though devastating form of injury and on an unusual technique to manage this situation .
when they do occur , they can be associated with corneal lacerations and scars , traumatic cataracts , choroidal hemorrhage , vitreous hemorrhage , retinal detachment , and even endophthalmitis .
once the fish - hook is impaled in the ocular structures , extraction can become a challenge for the attending surgeon .
however , we report a case where the uncommon technique of  cut - it - out  was successfully employed to remove the fish - hook out of the patient 's eye .
an 11-year - old boy was referred to our clinic with a history of injury to the right eye while fishing the day before .
apparently while pulling the line , the fish - hook flew to the patient 's right eye and got embedded in the cornea .
someone had cut the line and the dangling hook was taped to the cheek [ figures 1 and 2 ] .
patient on initial presentation the fish - hook on closer inspection on examination , the visual acuity was a perception of light ( pl ) ; with projection accurate in all quadrants in the affected right eye and 20/20 unaided vision in the left eye . the fish - hook had penetrated the cornea and impaled itself in the deeper tissues .
there was a settled hyphema and the deeper tissues were obscured by it and corneal edema .
a written consent was obtained from the parents for the removal of the fish - hook under general anesthesia .
we planned to use the commonly employed method of advancement of the fish - hook tip outside the cornea and snipping off the tip with wire cutters .
however , during the surgery , we found the hook stuck firmly to the underlying tissues .
the hyphema and edema were making visualization impossible . on trying to pull the fish - hook out , it got stuck in the cornea .
was then pushed in along the shank until the barb could be felt near the cornea .
this was then used to guide the fish - hook out of the eye [ figure 3 ] .
a subconjunctival injection of dexamethasone and gentamicin was given to complete the procedure [ figure 4 ] .
the fish - hook on extraction immediate post - extraction appearance at 1 week of follow - up , the eye showed minimal inflammation [ figure 5 ] .
the vision was still pl ; with accurate projection of light in the affected eye .
the damage to the iris at the pupillary margin and a traumatic cataract was visible .
fishing is an occupation or hobby for a vast number of individuals across the globe .
the coastline of malaysia itself extends for 4675 km and fishing is widely practiced here .
however , surprisingly , ocular injuries from fish - hooks are rarely seen . a recent search of the literature provided just one report of two cases from malaysia .
fish - hook injuries to the eye can involve the eyelids and the anterior- or posterior - segments .
there are five methods mentioned for fish - hook removal from the para - ocular or ocular tissues .
these include the following : ( i ) advance - and - cut technique . the hook is pushed forward until the tip and barb are outside the eye .
subsequently , wire cutters are used to cut the hook between the barb and the bend .
( ii ) back - out or retrograde technique . in this method , the hook is removed by simply backing it out through the entrance wound . as the barb can inflict more ocular damage during this maneuver , it is employed only for barbless fish - hooks .
this method is employed for removal of the fish - hook from non - ocular tissues .
the barb is covered with the needle to prevent it from entangling in the tissues and both are then withdrawn together . (
subsequently , the hook is backed out of the eye similar to the back - out technique .
patients with fish - hook injuries usually have corneal lacerated wounds and penetration of the lens , leading to traumatic cataracts . in our patient also , the hook had entered the cornea and was stuck in the deeper structures .
we also wish to perform a cataract extraction for our patient , once the inflammation subsides . as the cornea
is usually involved in these injuries , the usual sequel is corneal scarring . unless extensive ,
other complications reported include choroidal and vitreous hemorrhages , retinal tears , and retinal detachments .
endophthalmitis is also known to occur . in one patient , the endophthalmitis developed after three weeks of the injury .
the cut - it - out technique for fish - hook removal is an ideal option in cases where visualization is difficult . ultimately , prevention is the key .
 an 11-year - old boy was involved in an injury with a fish - hook to his eye . 
 the hook had impaled itself to the cornea and deeper structures . 
 there was associated corneal edema and hyphema , making visualization difficult . in this case 
 , we performed the unusual  cut - it - out  technique to remove the hook from the eye . 
INTRODUCTION
CASE REPORT
DISCUSSION