Unexpected finding in ocular surface trauma: a large intraorbital foreign body (bullet)

Sometimes intraorbital foreign bodies lead to unexpected findings. A 16-year old boy was referred due to ocular surface trauma. A conjunctival laceration was detected at the level of the left caruncle with associated left exotropia, reduced adduction as well as a preretinal hemorrhage along the nasal periphery of the fundus. A blow-out fracture of the medial orbital wall was suspected and a CT scan of the orbits was scheduled which revealed the presence of a large intraorbital foreign body. The removal of the intraorbital foreign body (which proved to be a bullet) and precautionary laser photocoagulation along the nasal periphery of the left eye were performed. Ocular surface trauma may reveal unexpected findings, such as an intraorbital foreign body, requiring investigation by a CT scan.