Injuries due to forceps delivery
Reviewed by Fiona Rowe

A retrospective series is presented of injuries secondary to forceps delivery over a 15-year period in 11 cases: seven male and four female. Follow-up of cases was over two months to 17 years. Eight presented within one week of delivery, one at two weeks, and one at two, 4.7 and 7.5 years for second opinion. Three cases had eye lid bruising with complete resolution. Two had vitreous haemorrhage and isolated unilateral hyphaema with complete resolution. Two had third nerve palsy – both requiring frontalis sling surgery. Both also had subdural haematoma and one with corneal injury. One case had VII palsy and secondary lagophthalmos with recovery to a minimal residual facial hemiparesis. Four cases had corneal injuries including vertical breaks in Decemet’s membrane. Oedema resolved in these cases but with persisting significant astigmatism. Vertical corneal scars were evident. All four had mild to severe amblyopia. The authors calculate a mean rate of 4.26% forceps assisted deliveries per year with a rate of ocular injury of one in every 413. There is potential for long-term visual loss. 

Forceps delivery-related ophthalmic injuries: a case series.
McAnena L, O’Keefe M, Kirwan C, Murphy J.
JOURNAL OF PEDIATRIC OPHTHALMOLOGY AND STRABISMUS
2015;52:355-9.