Needlefish (family Belonidae) are slender predatory fish with pointy beak-like jaws, most often found in shallow warm waters. They generally pose little threat to humans, but they have been reported to cause puncture injuries (1–11). Often the tip of the fish jaws breaks off and remains embedded in the injury site. It is believed that the fish mistake shiny objects such as jewelry and human eyes as prey. Approximately, one-half of the reported cases involve the head and neck, including several periorbital cases and 1 intracranial case (6–11). Limb and torso injuries also have been described (1,2).
In previously described cases, management almost always involved urgent removal of the fish jaw fragments that comprised bone, teeth, and some flesh. Because of location, the jaw fragment was not retrieved in our patient. Haider et al (8) described a patient who was initially managed similarly with observation, but because of persistent orbital inflammation days after injury, the fish jaw was ultimately retrieved. Our patient was managed successfully with antibiotics and observation. Although inflammation and/or infection were not encountered during our patient's follow-up period, the possibility remains that complications may be encountered in the future.
Category 1: a. Conception and design, C. Kum, J. R. Chang, A. M. Gruener, and T. J. McCulley; b. Acquisition of data, C. Kum, J. R. Chang, A. M. Gruener, and T. J. McCulley; c. Analysis and interpretation of data, C. Kum, J. R. Chang, A. M. Gruener, and T. J. McCulley. Category 2: a. Drafting the manuscript, C. Kum; b. Revising it for intellectual content, J. R. Chang, A. M. Gruener, and T. J. McCulley. Category 3: a. Final approval of the completed manuscript, C. Kum, J. R. Chang, A. M. Gruener, and T. J. McCulley.
1. Rouvillain JL, Donica A, Gane C, Zekhnini C, Garron E, Uzel AP. Windsurfing hazard caused by needlefish. Eur J Orthop Surg Traumatol. 2013;23(suppl 2):S295–S297.
2. Clark JJ, Ho HC. Two cases of penetrating abdominal injury from needlefish impalement. J Emerg Med. 2012;43:428–430.
3. Wolf M, Faibel M, Leventon G, Kronenberg J, Bendet E. Penetrating cervical injury caused by a needlefish. Ann Otol Rhinol Laryngol. 1995;104:248–250.
4. Ebner Y, Golani D, Ophir D, Finkelstein Y. Penetrating injury of the maxilla by needlefish jaws. J Craniomaxillofac Surg. 2009;37:235–238.
5. Bijoor P, Rourke T, Thomson H. Traumatic tympanic membrane perforation by a needlefish: case report. J Laryngol Otol. 2012;126:932–934.
6. McCabe MJ, Hammon WM, Halstead BW, Newton TH. A fatal brain injury caused by a needlefish. Neuroradiology. 1978;15:137–139.
7. Al-Abri M, Britton WA, Manusow JS, Brownstein S, Patel V, et al. Restoration of vision after surgical removal of an intraocular needlefish jaw. Retin Cases Brief Rep. 2012;6:298–300.
8. Haider A, Minckler DS, Yonkers MA, Tao JP. Orbital injury from needlefish impalement. Ophthal Plast Reconstr Surg. 2015;31:e170.
9. Ohtsubo M, Fujita K, Tsunekawa K, Yuzuriha S, Matsuo K. Penetrating injury of the orbit by a needlefish. Eplasty. 2013;13:e41.
10. Rahimian O, Hage R, Donnio A, Merle H. La mâchoire d'une orphie dans l'orbite (needlefish jaw in the orbit). J Fr Ophtalmol. 2013;36:e41–43.
11. Thakker MM, Usha KR. Orbital foreign body and ruptured globe from needlefish impalement. Arch Ophthalmol. 2006;124:284.