Multidisciplinary Approach for Vision Recovery after a Diving Accident with a Needlefish in Cancun

Needlefish (Strongylura Notata) are known to cause painful injuries in humans. There are several reports of serious puncture wounds to the chest, abdomen, neck, and extremities. In this report, we describe an impressive puncture lesion to the face that resulted in unilateral partial loss of vision with perforation of the cranial vault secondary to an encounter with a fish while diving. A 39-year-old female presented to the emergency department 1 week after a diving trip to Cancun with pain and swelling in the right orbital region. She had associated right-sided partial vision loss and a puncture wound on the right malar region. Computed tomography scan of the head showed two foreign bodies; one which crossed the orbit from the inferior lateral side displacing medially the optic nerve and into the cranial cavity. The second foreign body was located in the inferolateral side of the malar bone. Multidisciplinary surgical removal of the objects resulted in complete resolution of visual acuity deficits as well as total recovery of her diplopia. Fortunately, minimal limitation in the abduction of the right eye persisted.