A leech which had attached itself to an Australian woman's eyeball has been removed by doctors who had to think "outside the box".
The 66-year-old woman was gardening in the backyard of her suburban Sydney home in March last year, when she accidentally flicked some moist soil and the leech into her left eye.
Her husband then watched in alarm as the leech wriggled its way over her cornea, headed for safety and a feed via the eye's mass of delicate blood vessels.
The unusual case report is published in Emergency Medicine Australasia, the journal of the Australasian College for Emergency Medicine.
"It was tucked up underneath her upper eyelid," says emergency doctor Toby Fogg who helped to remove the blood-sucking critter.
"Our little fellow started off at about half a centimetre and by the time we removed it was about 2cm long - it had quite a good lunch."
Dr Fogg says tweezers were not an option as simply pulling the leech off could leave its head lodged in the eyeball, leading to infection.
A check of the medical literature revealed two other suggestions - using an anaesthetic on the eye to put the leech to sleep, or salted water.
The woman's husband had made an earlier unsuccessful attempt using salted tap water, before she went to Sydney's Royal North Shore Hospital.
"We numbed the eyeball so we could have a better look at it... but the leech wasn't apparently affected by it," Dr Fogg says.
Salt crystals also posed some risk of being "abrasive to the eyeball" and so doctors turned to a hospital staple - saline solution which has many uses, including being used in intravenous drips for people who lack enough salt in their blood.
"We thought `well why don't we try this`, it's just thinking outside the box," Dr Fogg says.
"It is available, cheap, and safe as far as using it on the eye is concerned and it worked beautifully, with just a few drops.
"The leech rolled straight off, it just fell on to her cheek so we put it in a pot and gave it to her."
Saline solution was now recommended for the treatment of people with leeches on their eyeballs, and Dr Fogg says that was not as rare as it sounded.
"In the several months subsequent we had two more (people) come in with leeches on the eye, just by pure coincidence," he says.
"The same treatment was used and they were successfully removed."
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