It’s spring. The magpies are breeding and they’re swooping. Jessica Chi advises on how you and your patients can avoid a direct hit and, in the event an attack does occur, how injuries should be treated.
Alexis,* a 28-year-old female, presented to my clinic reporting that she had been swooped by a bird on her right eye. She complained of a stinging, burning sensation and mild blur. She denied any discharge but reported weeping in the right eye. A mild myope and intermittent contact lens wearer, she was not wearing contact lenses at the time.
shallower wounds may be treated with ocular lubricants and antibiotic prophylactic cover… deeper lesions and corneal or scleral perforations may require surgical intervention
Vision with her spectacles was R and L 6/6.
Examination revealed a linear abrasion extending from the inferior temporal right conjunctiva onto the cornea (Figure 1). An ecchymosis above was also present (Figure 2).
Figure 1. A linear abrasion extending from the inferior temporal right conjunctiva onto the cornea.
Figure 2. Right eye laceration from a magpie attack.
Alexis was prescribed prophylactic antibiotics – chloramphenicol eye drops – to be used four times daily. When reviewed five days later, the laceration was completely resolved and the ecchymosis mostly dissipated.
Later that week, Joanne,* a 39-year-old female, presented following a magpie attack to her right eye while walking to work one hour prior. She reported that her eye felt a little sore and inflamed. She was weeping a little but denied any change in vision or discharge. Joanne had no previous ocular history of note. She was unrelated to Alexis but the attack had occurred at the same location.
Vision unaided was R 6/7.5+, L 6/6.
Examination revealed a diagonal linear abrasion in the infero-temporal conjunctiva adjacent to and just including the cornea (Figure 3).
Figure 3. Diagonal linear abrasion in the infero temporal conjunctiva adjacent to, and just including, the cornea.
Chloramphenicol eye drops were prescribed four times daily and Joanne was reviewed three days later, with the view of adding steroids if there was potential for scarring given the abrasion was in the line of sight. Fortunately, as the wound was very superficial, it was completely resolved when Joanne returned and vision in her right eye recovered to R 6/6.
TERRITORIAL BEHAVIOUR
In Australia, there were 4,500 reported magpie attacks in 2021, and 3,300 in 2022, of which approximately 13% resulted in injuries. They occur during magpie breeding season, which is from August to October (Figure 4),1 however both of these cases occurred in July 2023. They most commonly occur while victims are cycling and running, accounting for 70% and 20% of attacks respectively.1 The birds ‘swoop’, i.e. dive down to peck at humans, normally targeting the faces and in particular the eyes. Magpies are very territorial, especially during breeding season, and will attack when they feel threatened.
Figure 4. Magpie swooping attack counts each week in 2022.
ASSESSMENT AND TREATMENT
Treatment depends on the severity of the injury. First, if any foreign particles, e.g. dirt, etc are present, the eye should be irrigated, and any buried particles should be removed.
The depth of the wound should be assessed – shallower wounds may be treated with ocular lubricants and antibiotic prophylactic cover, whereas deeper lesions and corneal or scleral perforations may require surgical intervention where sutures or surgical glue may be required. Glues afford faster treatment times and reduced inflammation compared to sutures, thereby improving postoperative comfort. Signs of corneal perforation include positive Seidel’s test, a shallow anterior chamber, uveal tissue prolapse, and hypotony. If perforation has occurred, immediate closure of the wound is crucial to preserve corneal clarity and prevent secondary complications such as glaucoma or endophthalmitis.2
The use of corticosteroids and corneal injuries is controversial. Corticosteroids can be useful to inhibit inflammation secondary to the trauma, however, can worsen infective keratitis and delay wound healing. They should only be used when the infection is under control and when not prescribing increases the risk of corneal scarring. They also have the risk of increasing intraocular pressure and may lead to cataract formation. Fortunately, neither of these cases warranted the use of corticosteroids.3
In rare occasions, bird attacks have been known to result in open globe injuries, however fortunately, most cases do not result in penetrating eye injuries and tend to be superficial and managed without any consequence.4
If there is skin involvement, the wound should be cleaned immediately. The patient should consider a tetanus vaccine if the last shot was more than five years ago.
AVOIDANCE IS BEST
The best way to avoid magpie attacks is to avoid areas they nest in during breeding season. If the area cannot be avoided, protective eye wear and a wide brim hat are recommended. It is best to avoid provocation, as birds may attack if they feel threatened or are provoked, and sudden movements or actions may be perceived to be aggressive. Keeping a distance, and staying calm and still will reduce the probability of the bird feeling threatened.
Griffith University behavioural ecologist, Dr Darryl Jones, found that magpies are able to recognise people, with a magpie been able to recall up to 100 faces. If a subject is thought to be a prior threat, they may be targeted again by the same magpie. Victims of attacks should be counselled to avoid the same route until breeding season is over. Those who live near magpies can also befriend magpies by feeding them. In the same way they recognise threats, they will also recognise allies.
As optometrists we serve and work within a local community. If there are magpie attacks in the area it would not be amiss to alert the local community as well as avoiding the area for personal safety.
Find out more at this website dedicated to reporting magpie attacks www.magpiealert.com.
Jessica Chi is the director of Eyetech Optometrists, an independent specialty contact lens practice in Melbourne. She is the current Victorian, and a past national president of the Cornea and Contact Lens Society, and an invited speaker at meetings throughout Australia and beyond. She is a clinical supervisor at the University of Melbourne, a member of Optometry Victoria Optometric Sector Advisory Group and a Fellow of the Australian College of Optometry, the British Contact Lens Association, and the International Academy of Orthokeratology and Myopia Control.
*Patient names changed for anonymity.
References
1. www.magpiealert.com/Swooping-Magpie-Attack-Statistics-2022.
2. Sharma A., Sharma N., et al., Tissue adhesives for the management of corneal perforations and challenging corneal conditions. Clinical Ophthalmol; 2023:17 209–223.
3. Dang, D.H., et al., Treatment of non-infectious corneal injury: review of diagnostic agents, therapeutic medications, and future targets. Drugs 82, 145–167 (2022).
4. Eman M.A., Abdullah S.A., An unusual case of penetrating eye injury caused by a bird: A case report with review of the pertinent literature, Saudi Journal of Ophthalmology, 33(2), 2019,196-199.
