Presentation
Right eye penetrating injury.
Patient Data
Dense metallic foreign body "air rifle pellet" is noted inside the right orbit, lodged near its apex, associated with loss of normal contour of the right globe "flat tyre sign", posterior sclera buckling with hyperdense component and few vacuoles of intra-ocular gas and pneumo-orbit.
Full evaluation of optic nerve and cribriform plate fractures couldn't be done due to dense metallic artifact.
Diagnosis was made as right-side ruptured globe with vitreous haemorrhage, intra-ocular gas and pneumo-orbit.
Operative notes:
Steps:
conjunctival Peritomy around the tear was performed
wound explored
abscission of the prolapsed intra-ocular contents was done
scleral laceration sutured with multiple interrupted 8-0 vicryl sutures
conjunctival closure with 8-0 vicryl
full thickness sub-periosteal flap was raised along with the medial wall of the orbit
the medial wall of the orbit was exposed till the apex of the orbit
soft tissue dissection is done medially to palpate the foreign body
the foreign body was felt medially just above the optic foramen
foreign body retrieved with artery forceps
Lynch incision sutured using 4 and 5-0 vicryl sutures
haemostasis was achieved
Findings:
lid oedema
large sub-conjunctival haemorrhage with chemosis nasally
large scleral laceration extending from 1mm posterior to the limbus to 10mm posterior to the limbus along 1 o'clock with gross prolapse of intra-ocular contents
very hypotonus eye
total hyphaema obscuring the other details
a lead pellet was lodged at the rim of the optic canal, suggesting optic nerve damage
Case Discussion
A child with right-side ruptured globe due to penetrating injury by air rifle pellet while playing with his brother.
I would like to express my gratitude to SQH Ophthalmology Department doctors, for their valuable operative notes.
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