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21-year-old patient suffers vision loss following airgun accident

BMJ Case Reports authors have described their treatment of a patient who was left with a fractured pellet in his right eye

air gun
A 21-year-old patient was left with a fractured pellet in his orbital apex following an airgun accident.

BMJ Case Reports authors described how the man presented to an ophthalmology casualty unit seven days after the incident with a best corrected visual acuity of counting fingers in his right eye. Vision in his left eye was 6/6.

A CT scan revealed “multiple metallic foreign bodies” near the orbital apex.

Clinicians described how the location of the fractured airgun pellet made it difficult to plan for the removal of the foreign bodies without damaging the optic nerve.

The foreign bodies were left untouched with the patient receiving treatment with oral steroids.

After three weeks, the best corrected visual acuity in the patient’s right eye had improved to 6/9.

“I feel blessed that I have regained my vision,” a statement from the patient emphasised.

The affected eye had reduced contrast sensitivity, reduced visual field and partial red-green deficiency.

The authors highlighted that removing foreign bodies from the orbital apex carries a significant degree of risk.

It may be hard to locate the foreign bodies during the surgery, accidental injury may be caused to other orbital structures during the procedure or the foreign body may fragment during removal.

“Keeping these factors in mind many authors advocate ‘watchful waiting’ as an option for inert foreign bodies not causing significant symptoms, which was also done in our case,” the authors noted.