Delayed Sensory Exotropia With Retained Metallic Intraorbital Foreign Body

This report describes the longest case of a retained metallic intraorbital foreign body with no complications and development of delayed sensory exotropia following traumatic sclopetaria in childhood. A 9-year-old girl suffered a BB gun injury to the left eye, leading to chorioretinitis sclopetaria and loss of vision. The visual acuity was 20/800 with a relative afferent pupillary defect and choroidal rupture with subretinal hemorrhage that evolved to sclopetaria over time. Computed tomography of the orbit demonstrated the BB foreign body. A sensory exotropia of 30 prism diopters developed over time. Sclopetaria is an uncommon sequela of tangential but high velocity, non-penetrating, projectile injury to the globe. The force is sufficient to rupture the retina and choroid but not enough to rupture the globe. Most of the literature has focused on the initial management and visual outcomes for sclopetaria, not on the late sequelae, including ocular motility and alignment. Clinicians should take additional precautions in the surgical management of delayed sensory exotropia.