Article
Air-gun injury with localisation of the foreign body at the apex of the orbital cavity: an observation in the course of time
Search Medline for
Authors
Published: | September 22, 2004 |
---|
Outline
Text
Objective
Gun injuries of the orbital cavity can cause damages in the course of the bullet as well as surrounding reactions in the area of remaining bullets, depending on the localisation.
Case report
We demonstrate the case of a 14-year-old boy, who was hit by a bullet of an air gun in the orbital cavity. The bullet went past the left bulbus just under the eyebrow into the orbital cavity without hurting the bulbus. At the first visit the visual acuity was R 1,2 and L 1,0. The patient noticed diplopia in all directions, the elevation of the left bulbus was limited. A metal- dense foreign body could be detected in the X-rays/ CT near the optic nerve in the area of the apex of the orbital cavity. The pupils were isocor, no RAPD could be detected. The optic nerve head was with sharp margins and vital on both sides. A systemic antibiotic was given. 4 days after the accident, there was an increase of the lid edema and of the disturbance of motility. A RAPD and a decrease of visual acuity was detected. The pattern-VECP showed slight delay of the latency of P100, but no reduction in the amplitude. Dexamethasone was applicated against the focal inflammatory reaction. After the dosis of dexamethasone was reduced, there were several relapses, which could be dealt with by application of 50 mg prednisolone in decreasing dosage. In the CT an area surrounding the bullet could be visualized, which was meant to be organized sanguis or scar tissue. Under therapy with prednisolone, the compressing effect on the optic nerve was reduced, the visual acuity recovered to 1,0 and the RAPD improved. Since about half a year there are stable findings with only a discrete paresis in elevation of the left eye.
Conclusions
Foreign bodys at the apex of the orbital cavity can be left in place, if the local inflammatory reaction can be controlled by conservative measures.