Penetrating orbital injury by a nine-centimetre lead sinker

A male in his early 40s presented with a penetrating orbital injury after a nine-centimetre lead sinker was propelled into his right orbit while fishing. He reported pain, ptosis and visual acuity reduced to light perception. X-rays, preferred over CT due to metallic artefacts, revealed the sinker in the inferior orbital fissure with an intact eyeball. Initial surgical extraction attempts triggered a severe vagal response, necessitating endoscopic navigation for safe removal. Postoperatively, despite an intact globe, he developed vitreous haemorrhage and retinal detachment, requiring vitrectomy and silicone oil injection. Three months later, his visual acuity improved to 20/200, with normal blood lead levels. This case emphasises selecting imaging based on foreign body material, avoiding blind extraction using advanced tools if needed, monitoring for intraocular complications and assessing systemic toxicity risks.