Bite Injuries: Dog Bite in the Periorbital Region

 

A 9-year-old girl was bitten around the right eye by a neighbor's dog. She sustained multiple punctures and lacerations of the right upper and lower eyelids (A).

Animal bite injuries to the face and periorbital areas are a significant medical problem. Domestic dogs are responsible for more than 80% of all bites.¹ Animal bites can be categorized as avulsions, lacerations, puncture wounds, or crush injuries; most patients suffer a combination of these injuries.

Irrigate the bite wound with a virucidal and bactericidal agent such as povidone-iodine solution, and cleanse the wound thoroughly with soap and water. Prescribe antimicrobial prophylaxis to prevent contamination of the wound site by indigenous microbial flora and by microorganisms from the canine oral flora. The most commonly cultured bacteria from infected animal bite wounds are Pasteurella multocida and Staphylococcus and Streptococcus organisms.² Amoxicillin-clavulanate potassium, which inhibits b-lactamase, is a good treatment choice.¹

Tetanus prophylaxis depends on the patient's immunization history and the wound's susceptibility to tetanus. When rabies is a concern, confine and observe a healthy domestic dog or cat for 10 days. Have a veterinarian examine the animal and report any illness that arises during confinement to the local public health department. If the animal's history is not known, observe the animal for 10 days or destroy it immediately and test for rabies.

This patient's injuries were cleaned and surgically repaired. At 13-month follow-up, only a small scar remained on the right lower eyelid (B).

(Case and photograph courtesy of Leonid Skorin, Jr, DO.)

REFERENCES:

1. Bartley CB. Periorbital animal bites. In: Focal Points: Clinical Modules for Ophthalmologists. Vol 10. San Francisco: American Academy of Ophthalmology; 1992:1-8.

2. Goldstein EJ. Bite wounds and infection. Clin Infect Dis. 1992;14:633-638.