Hunting Firearm Induced Optic Nerve Transection

Penetrating ocular trauma caused by firearms represents a severe ophthalmic emergency and is frequently associated with poor visual outcomes. We report the case of a 41-year-old man who presented with complete loss of visual acuity (no light perception) after a penetrating injury to the right eye sustained during a hunting accident involving a low-velocity firearm. Initial ophthalmic examination showed a full-thickness nasal scleral perforation with vitreous prolapse, mild corneal oedema, and limited fundus visualization due to dense vitreous haemorrhage. A relative afferent pupillary defect of the right eye was present. Urgent orbital computed tomography demonstrated vitreous hemorrhage with intravitreal and peri-optic nerve air, as well as a 5-mm metallic pellet lodged within the intraconal fat near the orbital apex, without associated orbital fractures. The patient underwent urgent primary surgical repair within 6 hours of trauma, followed by intravitreal broad-spectrum antibiotic prophylaxis. Given the deep intraconal location of the pellet and the absence of compressive or infectious complications, the foreign body was left in situ to avoid the risks related to a surgical procedure in this area. Postoperatively, vision remained null and a traumatic inferior retinal detachment was diagnosed one week postoperatively. Observation was preferred to vitreoretinal surgical repair and the retinal picture remained stable at 1-month follow-up visit. This case highlights the role of computed tomography in penetrating ocular trauma. Integrating radiological and clinical findings is crucial to support diagnosis and prognosis as well as to avoid unnecessary surgical interventions.