Gun-related eye injuries: A primer

Gun-related eye injuries are relatively common in the context of gunshot wounds to the head and neck. Many of the fundamental principles of gunshot wound management apply to the care of these patients, but the complex anatomy and functional relationships of the periocular region do pose special challenges. We provide a focused primer for physicians seeking a more in-depth understanding of gun-related eye injuries and present 3 representative cases outlining the spectrum of pathology, provide a focused review of the relevant ballistics concepts, and discuss the management of injuries to the periocular soft tissues, orbital structures, and globe. We found that good cosmetic and functional results can often be achieved with appropriate early intervention, but visual prognosis may remain guarded despite optimal treatment.

[Penetrating air gun pellet into the orbital apex]

A foreign body penetrating into the intraconal orbital compartment poses a surgical challenge because of its deep location behind the globe and near the optic nerve. We present a case of an air gun pellet lodged into the orbital apex, which was removed via superolateral orbitotomy through coronal incision. This additional craniofacial technique is a safe procedure to access the lateral aspect of the intraconal compartment in the unusual event of having to remove an orbital foreign body.

Deep penetrating orbitocerebral steel spring injury with minimal sequelae: a case report

The authors report a penetrating orbitocerebral steel mattress spring injury without permanent ophthalmic or neurologic sequelae. A 44-year-old female mattress factory worker sustained an injury to her right orbit by a high-velocity projectile foreign body. Imaging revealed a metallic spring in the right orbit traversing the optic nerve and superior orbital fissure and lodging in the temporal lobe of the brain. Cerebral angiography demonstrated the steel coil around, but not damaging, the middle cerebral artery and other vessels. With a combined craniotomy and frontal orbitotomy, the spring was removed by meticulous counterclockwise rotation. Postoperatively, the patient had mild left-sided weakness that resolved after several weeks. Ocular examination was normal, including full extraocular movements and a visual acuity of 20/20 in each eye. The authors theorize that the spiral shape and on-axis rotational movement allowed the projectile to follow a path of least resistance penetrating deeply and coiling around, but not injuring, vital structures. Careful counterclockwise rotation under direct intracranial and intraorbital visualization was effective in removing the spring.