Transorbital globe sparing penetrating cranial injury with a metallic screw: large cranio-orbital foreign body

Description

A 14-year-old man presented to the emergency services following trauma to his left eye (LE) sustained during a battery explosion. The patient was conscious, and oriented in time, space and person, and higher mental functions were preserved. The patient had visual acuity of light perception in his left eye. Head of a metallic screw could be seen on ocular examination and the screw appeared to penetrate the left superior orbit through the upper eyelid (figure 1A). Details of the eyeball could not be visualised, though the cornea appeared opacified. Intraocular pressure could not be assessed on digital palpation due to severe lid oedema. The fellow eye was within normal limits. Ultrasound was avoided in view of suspected open globe injury. An urgent CT scan was advised which revealed the extension of the foreign body (FB) into the basi-frontal lobe of the left cerebral hemisphere (

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