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
hemostasis was achieved
Findings:
lid edema
large sub-conjunctival hemorrhage 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 hyphema obscuring the other details
a lead pellet was lodged at the rim of the optic canal, suggesting optic nerve damage