gms | German Medical Science

102. Jahrestagung der DOG

Deutsche Ophthalmologische Gesellschaft e. V.

23. bis 26.09.2004, Berlin

Air-gun injury with localisation of the foreign body at the apex of the orbital cavity: an observation in the course of time

Meeting Abstract

Search Medline for

  • corresponding author L. Hefner - Klinik und Poliklinik für Augenheilkunde, Universität Leipzig
  • H. Tegetmeyer - Klinik und Poliklinik für Augenheilkunde, Universität Leipzig
  • I. Sterker - Klinik und Poliklinik für Augenheilkunde, Universität Leipzig

Evidenzbasierte Medizin - Anspruch und Wirklichkeit. 102. Jahrestagung der Deutschen Ophthalmologischen Gesellschaft. Berlin, 23.-26.09.2004. Düsseldorf, Köln: German Medical Science; 2004. Doc04dogP 198

The electronic version of this article is the complete one and can be found online at:

Published: September 22, 2004

© 2004 Hefner et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.




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.


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.