Self-inflicted, trans-optic canal, intracranial penetrating injury with a ballpoint pen

Trans-orbital penetrating injuries are not common. If not promptly treated, these injuries can lead to serious disabilities and even death. A 60-year-old man, who had multiple underlying diseases, was admitted to our medical ward for the treatment of aspiration pneumonia; he attempted suicide by inserting a ballpoint pen into his left eye. CT of the brain showed a foreign body penetrating through the left optic canal into the intracranial parasellar region without obvious intracranial haemorrhage. The foreign body was withdrawn smoothly at bedside without a craniotomy. The patient was then transferred to the ICU for neuro-observation. The patient recovered with complete left ophthalmoplegia but intact visual function. Acute management of a trans-orbital penetrating injury involves prompt neuroimaging examinations and knowledge of common recurring patterns of injury. All clinicians should be aware of the psychological condition of each patient, and suicide precautions should be considered during clinical practice.