Posterior intraorbital metallic foreign body: a case discussion

Area of Science:

• Ophthalmology
• Trauma Surgery
• Radiology

Background:

• Intraorbital foreign bodies (IOFBs) from gunshot wounds are rare but pose management challenges, particularly when posteriorly located.
• Self-made gun usage for hunting in certain regions increases the incidence of such injuries.
• Limited literature exists on managing posterior IOFBs without visual impairment.

Purpose of the Study:

• To report the challenges in managing a patient with a posteriorly located metallic IOFB.
• To discuss appropriate management strategies based on international literature.
• To highlight the potential for conservative management in specific IOFB cases.

Main Methods:

• Case report of a 37-year-old male farmer with gunshot injuries.
• Computed tomography (CT) scan to identify the location and extent of metallic foreign bodies.
• Review of international literature to guide management decisions.

Main Results:

• CT scan revealed metallic bullet pellets in the left orbital floor, mandible, and frontal bone, all extracranial.
• The patient had no neurological deficits or visual impairment and refused surgery.
• Conservative management with observation was chosen based on literature review.

Conclusions:

• Metallic IOFBs in the posterior orbit can be conservatively managed with observation and regular follow-ups.
• Conservative management is suitable when there are no signs of inflammation, infection, optic neuropathy, or functional deficit.
• This approach avoids unnecessary surgery and the risk of iatrogenic injury to the eye.