Tetanus following ocular wooden foreign body in incompletely vaccinated patient: a case report

Tetanus is defined by the acute onset of hypertonia or by painful muscular contractions (usually of the muscles of the jaw and neck) and generalized muscle spasms without other apparent medical cause[1]. It is a form of spastic paralysis mediated by the neurotoxin “tetanospasmin” released by the Clostridium tetani bacteria germinating in relatively anaerobic wounds or ulcers, especially after contamination with soil. Tetanus caused by ocular injuries are rare and there are only few reported cases in medical literature[2,3]. Orbital injuries with wooden foreign bodies are highly infectious although they are uncommon[4]. Treatment of tetanus involves thorough debridement of affected wounds, symptomatic and supportive measures to relieve spasms and intravenous antibiotics[1]. Surgical exploration may appear less appealing in orbital trauma as the risk of injury to its vital contents but all suspicious injuries need imaging followed by surgical intervention[5]. Because of effective vaccination programs, tetanus is rare in developed countries although it is reported in fully immunized subjects[1,6].