Intrabulbar, Intraorbital and Intracranial Perforating Eye Injury with Foreign Body: A Case Report

Ocular trauma is a significant cause of preventable blindness and visual impairment worldwide. Eye globe perforation can happen due to work with sharp tools or different particles that are spread during work with metals, wood, and other solid substances. We present the case of a 14-year-old male patient admitted as an urgent case at the Ophthalmology Department in 2014 due to a perforating eye injury with a foreign body - a 7 cm rusty metallic nail in the right eye. The X-ray of the orbit revealed that the foreign body had penetrated the eyelid, the eye eyeball, and through the orbit and its posterior wall, penetrated the skull and 2 cm in the brain. Under general anesthesia, we performed the anterior chamber lavage, excision of the prolapsed iris, and pupilloplasty. The anterior chamber was reconstructed using a saline solution (0.9% NaCl) and air. The patient was treated conservatively with antibiotics and steroids for 10 days; there were no signs of wound filtration, hypotonia, or endophthalmitis. Due to the limited resources for the posterior segment surgery, the patient was referred to another center for pars plana vitrectomy (PPV) after 10 days of hospitalization in the Department of Ophthalmology at the University Clinical Center of Kosovo. After PPV with silicon oil and cataract surgery, the patient could see the light and its projections (BCVA = L+P+). We followed up on the patient until September 2022, there were no signs of bulbus atrophy, and the visual acuity remained the same, BCVA = L+P+. The correct diagnosis and treatment at the right time play a leading role in achieving one of the main goals of surgical treatment of perforating eye injuries, which is the preservation of the anatomical structure and the physiology of the eye.