Keeping An Eye On

Nervous System & Special Senses

Step 1: View Clinicals

A 10-year-old boy presents with sudden, severe left eye pain, after that eye was struck by a ricocheting pellet while shooting a BB gun with a friend. He was not wearing protective or prescription glasses at that time.

There are no complaints related to the right eye, and he has no history of ocular trauma, surgery, glasses, or contact lens use. His medical history is unremarkable and he is currently not on any medications.

Step 2: Order Relevant Investigations

1. X-ray skull AP & Lateral views


A single round opacity highly suggestive of a metallic foreign body is seen within the orbit. All other bony structures appear to be normal.

2. CT bilateral orbits


The CT reveals a round, metallic foreign body at the level of the iris plane on the left side. All the other orbital structures appear normal.

3. MRI brain


You recall that MRI should not be performed on patients who have or are suspected to have metallic foreign bodies.

4. Electroretinography


You realize that this is not the right time for an electroretinography.

Step 3: Select Appropriate Management

1. Tetanus prophylaxis


2. Fox eye shield


3. Surgical removal of foreign body


4. Intravitreal antibiotics