Case study of an orbital screwdriver injury

1. A man struck himself in the right eye with a screwdriver. The initial diagnosis was probable medial wall fracture with medial rectus entrapment, but a forced auction test result was negative and the initial x-ray study of the orbit and sinuses was within normal limits. The patient was treated with topical antibiotics and observed closely. Subsequent exams revealed a complete, isolated right gaze palsy. 2. An axial computed tomography scan of the orbit revealed an area of a probable hematoma overlying the lateral rectus muscle. There was also a fracture of the greater wing of the spheroid. 3. One month after the injury, the patient had complete, spontaneous clearing of the diplopia and lateral gaze palsy. The patient has had no residual effects 3 years later. This care reinforces the idea that injuries such as this should be treated symptomatically and observed.