engleski

Twelve-year-old girl with a gunshot wound to the head

A 12-year-old girl presented to the emergency department after being shot with a .177 (4.5 mm) air gun stuffed diabolo pellet. The pellet shot the girl’s left infraorbital. The entry wound in a size of 3 mm was barely noticeable, located 0.9 cm below the lower eyelid and 3.6 cm laterally to the nasal sidewall. Before the accident, her ocular history included diplopia (anamnestically, the girl’s mother said that the girl had diplopia before but she was never referred to an ophthalmologist). At the first examination, the mydriasis and ptosis on the left eye were noticed. The left pupil did not react to the light. The right eye status was normal. After an emergency craniogram was performed, a foreign body was verified in the projection of the left orbit. Upon the arrival of an ophthalmologist, the eye status was as follows: visus oculi dextri (VOD) sine correctione (sc) 1.0, visus oculi sinistri (VOS) sine correctione (sc) 0.5, left bulbus in exodeviation of 10 PD with convergence insufficiency, double vision in the direction of looking straight, occasionally in elevation and depression, with no double vision in the terminal abduction right and left. The girl did not notice the pain. The pupil was in the mydriasis with a very slow motion in the light. Other status of the anterior eye segment as well as of the eye fundus was normal. A computed tomography scan showed a metallic foreign body in the left orbital conus, without fractures or intracranial intrusion. Immediate tetanus prophylaxis, antimicrobial therapy (amoxicillin/clavulanic acid, metronidazole), neuroprotective therapy (methylprednisolone) and local therapy (tobramycinum) were introduced. Given the high risk of surgical treatment, the girl was conservatively treated and monitored. The girl was relieved of physical activity at school due to the possibility of moving the foreign body. Three years after the injury, the girl has only a pupil in semi mydriasis and a slower reaction to direct light. The visual acuity is as follows: VOD sc 1.0, VOS sc 0.9. Other eye status is normal.

bullet ; orbit ; gunshot wound

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