J Korean Ophthalmol Soc.  2009 Apr;50(4):649-655. 10.3341/jkos.2009.50.4.649.

A Case of Intraorbital Foreign Body After Gunshot Wounds

• Kim ST
• Kim DH

• KMID: 2212271
• DOI: http://doi.org/10.3341/jkos.2009.50.4.649

Abstract

PURPOSE: To report a case of an intraorbital foreign body after gunshot wounds. We describe this injury and report the treatment outcomes.
CASE SUMMARY
A patient who had been previously shot in his left zygomatic bone by an airgun visited our hospital complaining of visual disturbance in February of 2007. No external injuries on any part of the patients' body or abnormal neurological signs were observed. Ophthalmic examinations including a visual acuity test, slit lamp examination, pupillary light reflex test, fundus examination, skull X-ray, and computed tomography (CT) were performed. Upon initial examination, his visual acuity was hand motion. The pupillary light reflex test revealed an afferent pupillary defect in the left eye. Additionally, chemosis and eyelid edema were observed; however, no abnormal findings for the retina were observed in the fundus examination. Orbital computed tomography revealed metallic foreign bodies in the intraorbital retrobulbar space and partial injury of optic nerve was observed. Rather than surgical foreign body removal, antibiotic treatment was enforced with no complications other than approximately 12 prism diopters of exodeviation of the left eye in a Krimsky prism test after the course of a year. As for the patient's vision, the visual acuity of the left eye remained the same as before treatment, but revealed an improvement of 0.1 in left gaze.
CONCLUSIONS
We report a case of a gunshot injury in the intraorbital retrobulbar space without aggravation of visual function and complication despite the foreign bodies not being removed.

Keyword

Gunshot; Intraorbital foreign body

MeSH Terms

Edema
Exotropia
Eye
Eyelids
Foreign Bodies
Hand
Humans
Light
Optic Nerve
Orbit
Pupil Disorders
Reflex
Retina
Skull
Vision, Ocular
Visual Acuity
Wounds, Gunshot

Figure

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  Figure 1. Orbital CT findings at the initial visit. (A) Metallic foreign bodies were detected in the posterior orbit. (B) Zygoma fracture and outer orbital wall fracture were seen. (C) Partial laceration of the optic nerve was seen (arrow).

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  Figure 2. Goldmann perimetry 17 months later showing a small central temporal field remains.

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  Figure 3. Fundus photograph findings 17 months later showing pale optic disc of the left eye.

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  Figure 4. Orbital CT findings 17 months later (A) Axial view. A metallic foreign body was impacted on the optic nerve. (B) Coronal view. (C) Sagittal view.

Reference

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