Abstract
BackgroundIntraorbital metallic foreign bodies have varied clinical presentations. Here, we report the unusual case of intraoperative evidence of spontaneously healed posterior scleral perforation in a severe ballistic trauma without previous instrumental signs of penetrating wound and complete visual restoration after surgery.Case presentationThe patient was hit by several lead hunting pellets in the chest, abdomen, limbs, face and orbit. Computed Tomography (CT) images revealed the presence of a pellet within the orbitary cavity, close to the optic nerve, with no signs of penetrating ocular wound. While performing vitrectomy for severe vitreous hemorrhage, a point of strong adherence between a old hemorrhage and retinal surface was identified and managed conservatively, as it was attributed to trauma related-impact area. So, lead foreign body took an unusual trajectory impacting the globe and finally lodging back in the deep orbitary cavity, in absence of significant ocular injury and with visual prognosis preservation.ConclusionsOur findings provide further information on orbital injuries from airguns, a theme of growing popularity and concern. Intraoperative recognition of hardly removable old hemorrhagic clot as self-blockage site of posterior scleral penetrating trauma, allowed for surgical stabilization and minimal solicitation of the area to avoid inadvertent perforation.
Highlights
Intraorbital metallic foreign bodies have varied clinical presentations
Computed Tomography (CT) scans of the orbital region revealed the presence of a hunting lead pellet within the orbitary cavity, supero-temporally close to the optic nerve, in the deep retrobulbar space between the optic nerve and the lateral rectus muscle, with no penetrating wound of the globe (Fig. 2)
The patient was evaluated by complete ophthalmological examination including measurement of the best-corrected visual acuity (BCVA), intraocular pressure, slit lamp biomicroscopy, mydriatic indirect
Summary
Our findings provide further information on orbital injuries from airguns, a theme of growing popularity and concern. Intraoperative recognition of hardly removable old hemorrhagic clot as self-blockage site of posterior scleral penetrating trauma, allowed for surgical stabilization and minimal solicitation of the area to avoid inadvertent perforation
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