Owner-inflicted ocular injuries: A novel study of dog bite trauma caused by familiar pets: A case series

Abstract

Introduction and importance

This novel study aims to investigate ocular injuries caused by dog bites inflicted by the victims' own pets. The study examines the types of injuries, the breeds of dogs involved, the demographics of the victims, and the clinical management strategies used. It also seeks to highlight the need for preventive measures and the importance of responsible dog ownership in minimizing these injuries.

Case presentation

A retrospective review of medical records from Shiraz Eye Center, Khalili Hospital, between 2022 and 2024 was conducted for patients who suffered ocular trauma from bites by their domestic dogs. Only patients with identifiable dog breeds were included. Data collected included patient age, gender, injury type, surgical intervention, medical management, outcomes, and complications. All patients underwent surgery within 2 days of injury and were followed up for at least 3 months. The majority of patients (71 %) were between 12 and 28 years old. Rottweilers and German Shepherds were the most commonly involved breeds. The most frequent injury was lower canaliculi lacerations (57 %), with some cases presenting both lower and upper lid margin lacerations. Surgical interventions primarily involved canalicular repair with Crawford stents and lateral tarsal strip procedures. Complications included ectropion and telecanthus in two cases, but no visual impairments were noted.

Discussion

This study underscores the significant risk of ocular injuries inflicted by owners' own dogs, with young individuals being the most affected group. Rottweilers and German Shepherds were the most frequently involved breeds, but smaller breeds like Pomeranians also caused serious injuries. Lower canalicular lacerations were the most common injury, reflecting the anatomical vulnerability of the central facial region. Timely surgical intervention, primarily canalicular repair with Crawford stents and lid margin repairs, yielded positive outcomes with minimal complications. These findings emphasize the importance of responsible pet ownership, public education, and preventive strategies to reduce such injuries. Additionally, the psychological impact of these injuries, particularly in children, remains an area requiring further research.

Conclusion

This study highlights the risks of ocular injuries from dog bites inflicted by familiar pets. It emphasizes the importance of responsible dog ownership, public education, and preventive measures, particularly for vulnerable groups. Further research into the psychological impact of these injuries and larger studies are needed to develop effective prevention strategies.

Highlights

• •Purpose: Study on ocular injuries from dog bites, focusing on injury types, dog breeds, and patient care.
• •Methods: Retrospective study at Shiraz Eye Center (2022–2024), analyzing demographics, injury types, and surgeries.
• •Results: Common injuries: lower canalicular lacerations (57 %). Most frequent breeds: Rottweilers & German Shepherds.
• •Conclusion: Emphasizes responsible dog ownership and public education to prevent injuries.
• •Future research: Focus on long-term outcomes, psychological impact, and broader studies.

1. Introduction

Dog bites are a significant public health concern globally, with millions of incidents reported annually[1]. They can cause severe ocular injuries. In the United States, dog bites account for up to 1 % of emergency room visits, with young children being more vulnerable to head and neck injuries [2]. Children are more than four times more vulnerable than adults, and they represent the majority of these bite victims. Children aged 5–9 experience the highest facial and ocular bite rates [[2], [3], [4]]. However, ocular injuries are less frequent, but they significantly impact morbidity and management needs and can burden the health economy [5].

The incidence of facial injuries involving the ocular region was reported at 1.7 per 100,000 person-years; dog bites' most common injuries are eyelid lacerations, canalicular lacerations, and, less frequently, orbital fractures or globe ruptures. Injuries commonly occur at home or in a familiar setting, which can emphasize the importance of public education and dog owner awareness. [6,7].

These bites are often associated with certain breeds and are influenced by the dogs' temperament, size, and strength. Large breeds like Pit Bulls, German Shepherds, Rottweilers, and Labrador Retrievers are more frequently involved in severe injuries. [2,7].

This novel study examines ocular injuries caused by patients' own dogs, analyzing injury types, associated breeds, circumstances, and victim demographics. It evaluates clinical management outcomes and emphasizes prevention, responsible dog ownership, and public awareness to reduce such incidents.

2. Methods

This study was conducted following the Declaration of Helsinki guidelines. According to the research ethics committees of Shiraz University of Medical Sciences, this study is exempt from ethical approval. As a retrospective study, formal patient consent was waived. This study follows the Preferred Reporting of Case Series in Surgery (PROCESS) 2023 guidelines to ensure transparency and rigor in reporting. [8]

The medical records of the Ophthalmic Service at Shiraz Eye Center, Khalili Hospital, were reviewed for all patients who suffered dog bites from their domestic dogs between January 2022 and December 2024. The review included emergency reports and medical records for these patients bitten by their dogs. Only patients for whom the breed of dog could be definitively identified were included. The documents were examined for the patient's age and gender, identification of ophthalmic and systemic injuries, nature of surgical interventions, medical care provided, outcomes, and complications, and the month in which the incidents occurred.

All patients in this study underwent surgery within 2 days of the injury and were followed up for a minimum of 3 months.

2.1. Non-surgical intervention

Primary management of these injuries included thorough wound cleaning with saline irrigation to reduce infection risk. Prophylactic antibiotics, such as Amoxicillin-clavulanate, were essential due to the polymicrobial nature of dog saliva. Additionally, tetanus and rabies prophylaxis were necessary if the vaccination status of the biting dog was uncertain. [2,9].

2.2. Surgical interventions

All surgical procedures were performed by an experienced ophthalmologist specializing in eye care at Shiraz Eye Center. Complex cases were managed through interdisciplinary consultation with maxillofacial and plastic surgeons. To ensure consistency and reliability, all surgical interventions followed a standardized protocol:

• •Preoperative assessments were reviewed by two independent ophthalmologists.
• •Surgical techniques adhered to established guidelines for canalicular repair and lid margin lacerations.
• •Postoperative evaluations were conducted by the same clinical team to minimize observer bias.

2.3. Canalicular laceration

The Crawford bicanalicular intubation procedure began by inserting the olive-tipped guide into the punctum, advancing it 2 mm, and making a 90-degree turn to follow the canaliculus. The guide was then passed through the nasal end of the lacerated canaliculus, reaching the lacrimal sac fossa. It was rotated to follow the direction of the lacrimal duct. Silicone tubes were secured with a knot inside the nose, ensuring no tension on the puncta. The knot could be sutured to prevent inadvertent tube displacement.[6].

2.4. Lid margin laceration

Vertical mattress 5–0 or 6–0 Vicryl sutures were used to approximate the tarsus—typically three sutures for the upper eyelid and two for the lower. The anterior lash line was secured with 6–0 silk sutures. Skin closure was achieved using interrupted 6–0 plain gut sutures, with eyelid margin suture tails buried. Antibiotics and wound dressing were applied upon completion of the procedure[10].

3. Results

We reviewed 7 cases of dog bite injuries and all were included in this study. 57 % of the patients were female, and 43 % were male. The age of the patients ranged from 12 to 54 years, with the majority (71 %) being between 12 and 28 years old. The most common dog breeds involved were Rottweilers and German Shepherds, each responsible for 29 % of the injuries, followed by Pomeranians and Pitbulls at 14 % each. The dogs mainly were aged 3 to 4 years, accounting for 71 % of the cases (Fig. 1).

Fig. 1.

The patient was bitten by their Rottweiler dog, presenting with severe eyelid lacerations and a lower canalicular laceration.

Regarding the nature of the injuries, 57 % of patients suffered lower canaliculi lacerations, while 29 % experienced both lower and upper lid margin lacerations. Management strategies primarily involved canalicular repair with Crawford stents and lateral tarsal strip procedures (71 %), while lid margin repair was performed in 29 % of cases. All patients were followed for three months post-surgery, and none experienced visual impairments. However, one patient developed ectropion, and another patient had both ectropion and telecanthus. In terms of month distribution, two occurred in July, one in May, one in October, one in June, one in August, and one in April. (Table 1).

Table 1.

Patient demographics, types of injury, management strategies, and complications.

Gender	Age	Dog breed	Age of the dogs	Type of injury	Management strategy	complication	Month
Female	54	Rottweiler	3	Lower canaliculi laceration	Canalicular repair with Crawford stent with lateral tarsal strip	Ectropion	July
Female	12	German Shepherd	4	Lower lid margin laceration	Lid margin repair	None	August
Female	25	Pitbull	3	Lower and upper canaliculi laceration	Canalicular repair with Crawford stent with lateral tarsal strip	Telecanthus and ectropion	April
Male	17	Pomeranian	5	Lower canaliculi laceration	Canalicular repair with Crawford stent	None	October
Female	15	German Shepherd	4	Lower and upper lid margin laceration	Lower and upper lid margin repair	None	June
Male	34	Pomeranian	2	Lower lid margin laceration	Lid margin repair	None	May
Male	28	Rottweiler	4	Lower canaliculi laceration	Canalicular repair with Crawford stent	None	July

4. Discussion

Our novel study highlights the significance of patterns in ocular injuries inflicted by dogs owned by bite victims.

The majority of our cases involve young individuals aged 12 to 28, aligning with previous research indicating increased vulnerability in this group due to their frequent interactions with animals during recreational and household activities. [3].

Our findings indicate that Rottweilers and German Shepherds were the breeds most frequently linked to these injuries (Table 1). This trend may be attributed to their larger size and propensity to focus on the central facial region during attacks, consistent with patterns reported in previous research[2,3]. However, this case series study emphasizes owner-inflicted injuries, highlighting that even smaller breeds like Pomeranians can cause significant damage (Fig. 2A-B). Including smaller breeds provides a more nuanced understanding of risk factors, which is rarely addressed in existing studies examining larger and more aggressive breeds. This expands the discourse beyond aggressive or large breeds, emphasizing that all dogs can be a potential risk, especially when provoked. [7].

Fig. 2.

A: the patients who were bitten by their own Pomeranian dogs and sustained lower canalicular lacerations.

B: the same patient three months after the injury, with no complications, following surgery with a Crawford stent for the lower canalicular laceration.

The findings show a higher prevalence of lower canaliculi laceration (57 %) and a combination of lower and upper lid margin lacerations (29 %). Our series supports that lower canalicular lacerations are a predominant feature of dog bite injuries. This finding may be linked to the anatomical vulnerability of the lower canaliculus in the central facial region, which is frequently targeted. [7,9]. Similar to previous articles, lower canalicular lacerations are more common due to the dog's tendency to target the central face region.[2]. Savar et al. also reported a high prevalence of canalicular lacerations in dog bite injuries, which echoes the findings in this case series.[9].

Surgical interventions, primarily canalicular repair with Crawford stent and lateral tarsal strip procedures, were effective in managing the injuries, with minor complications such as ectropion and telecanthus occurring in two cases. These results highlight the effectiveness of timely and specialized surgical management in maintaining both function and appearance. [11] Additionally, the absence of visual impairments in all patients in our series highlights the benefits of timely surgical intervention and comprehensive postoperative care.

While most existing literature focuses on injuries from unfamiliar dogs, our case study provides a unique perspective by examining injuries caused by familiar dogs, which present distinct challenges. Owners of these breeds must exercise extra caution, as even typically friendly dogs can cause harm under stress. Public education, early behavioral training, and supervision are essential to minimize risks, especially for vulnerable groups like children. Additionally, the psychological impact of these injuries on victims and their families is often overlooked and warrants further exploration in future studies.[11]. Studies show that children can develop PTSD, with symptoms like fear, nightmares, anxiety, and avoidance, especially when the attack is severe. Parents also experience emotional distress, including guilt, fear, and changes in behavior.[12]. These effects highlight the need for more research on the long-term psychological consequences of dog bites.

This study is the first to specifically examine ocular injuries caused by owners' own dogs rather than stray or unfamiliar animals, offering a unique perspective on the risks associated with pet ownership. It provides detailed documentation of surgical outcomes, including canalicular and lid margin repairs, which enhances the understanding of treatment effectiveness. Additionally, the study includes a diverse representation of dog breeds, both large and small, allowing for a more comprehensive assessment of risk factors associated with different types of dogs.

While our study provides valuable and new insights, its limitations include its small sample size and retrospective design. Future research should involve larger, multicentral studies to validate these findings and explore preventive measures. Additionally, public education with the primary goal of safe interactions with all breeds, regardless of size, could help to minimize the risk of injuries.

5. Conclusion

This novel study highlights the significant patterns of ocular injuries caused by dog bites inflicted by familiar dogs. The findings emphasize the importance of responsible dog ownership, breed awareness, and public education to reduce the risk of such injuries, especially in vulnerable groups like children. Surgical management, including canalicular repair and lid margin repair, demonstrated positive outcomes with minimal complications. However, the psychological impact of these injuries remains an underexplored aspect that warrants further investigation. Future studies should focus on larger samples and preventive strategies to enhance safety and awareness.

Contributions

Alireza Attar contributed to the conception, design, and supervision of the study. Alireza Attar, Alireza Askari, and Amirmohammad Fathian carried out material preparation and data collection. Alireza Attar, Alireza Askari, and Amirmohammad Fathian wrote the manuscript. All authors reviewed and approved the final manuscript.

CRediT authorship contribution statement

Alireza Attar: study concept or design, data collection, data analysis or interpretation, writing the paper.

Alireza Askari: study concept or design, data collection, data analysis or interpretation, writing the paper.

Amirmohammad Fathian: study concept or design, data collection, data analysis or interpretation, writing the paper. All authors have read and approved the final manuscript.

Consent for publication

The participants in the study were fully informed about the goals, cooperation, benefits, and potential harms of the study and completed the ethical consent forms.

Ethics approval and consent to participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of The Human Ethics Committee of Shiraz University of Medical Sciences and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The participant in the study were fully informed about the goals, cooperation, benefits, and potential harms of the study and completed the ethical consent forms.

Guarantor

Alireza Attar.

Funding

The authors received no funding for the study from any organization.

Declaration of competing interest

The authors declare that they have no conflict of interest. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. This study is exempt from ethical approval. Written informed consent was obtained from the patient for publication and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.