Case report

A 35-year-old man, with no significant medical history, presented to the emergency department after having been subdued with a TASER head shot. He had been struck in the left medial canthus by one of two TASER dart electrodes fired at a distance of 4 m while he was trying to jump out of a window following a period of agitation.

The patient was not in pain and a neurological examination was unremarkable. The TASER probe was noted to have become deeply embedded in the left medial canthus ( Fig. 1 ), without causing any ocular lesions. A computed tomography scan of the head was obtained before making any attempt to remove the probe. This revealed the tip of the probe to have penetrated and become embedded in the left nasolacrimal duct and showed a displaced ethmoid fracture (lamina papyracea) ( Fig. 2 ).

Photograph of the TASER probe embedded in the left medial canthus.

Preoperative computed tomography scans. Top left panel: axial section showing the point of the TASER dart in the left nasolacrimal duct. Bottom left panel: axial section showing the ethmoid (lamina papyracea) bone fracture. Right panel: three-dimensional CT scan reconstruction showing the embedded probe.

As a matter of urgency the patient was taken to the operating room to have the dart removed under general anaesthesia and for an exploration of the lacrimal system. A superficial electrical burn was observed on the skin of the medial canthus, with a miniscule ecchymosis around the point of entry of the dart and the medial part of the superior eyelid. A left upper paranasal incision was made and prolonged in the medial suborbital region. The dissection was carefully extended along the probe to the frontal process of the maxilla and the nasolacrimal duct. The point of the XP TASER probe was slowly removed, under direct visualization, with a firm pull directed perpendicular to the bone surface. The probe exhibited no resistance to removal.

The canalicular injuries were assessed with a lacrimal probe. The superior canalicular was safe, but an inferior canalicular transection was highlighted by visualizing the lacrimal probe in the wound bed, approximately 7 mm from the inferior lacrimal punctum. The localization of the distal edge required the use of loupe magnification, and this was finally located in the orbicularis muscle. The decision was made to repair the lacerated canaliculus with direct canalicular sutures without intubation (neither direct nor retrograde lacrimal catheterization were possible) under loupe magnification. A direct anastomosis of the cut ends of the canalicular mucosa was accomplished with a non-absorbable Ethilon 9-0 suture. Irrigation of the ducts highlighted the permeability of the anastomosis and the lacrimal system. The skin was closed with a dermal absorbable PDS 5-0 suture and an interrupted non-absorbable superficial Ethilon 6-0 suture.

The patient was given intravenous antibiotics (amoxicillin–clavulanate 1000/200 mg every 8 h), intravenous analgesics (paracetamol 1000 mg every 6 h), and eye drops (vitamin A, picloxydine dihydrochloride, carmellose sodium every 8 h). The postoperative course was uneventful and the patient left the hospital 2 days later with a prescription for oral analgesics and eye drops. One year later the patient presented no symptomatic epiphora and no lacrimal fistula.