Grand Rounds Amir R Hajrasouliha M D University

Grand Rounds Amir R. Hajrasouliha, M. D. University of Louisville Department of Ophthalmology and Visual Sciences Thursday, December 5 th, 2014

Patient Presentation n CC: BB gun shot in the face n HPI: 14 y/o male, previously healthy boy, was out at his friends house playing with BB gun. Friend pointed the gun and accidentally shot him in the right corner of the right eye from 3 feet away. Patient complained of mild blurred vision and pain in the eye movement. He denied any double vision.

Patient Presentation n PMH: ADHD (attention deficit hyperactivity disorder) n POH: None n Meds: Methylphenidate n Allergies: None

Exam VA (n, sc) 20/25 20/20 Tp 25 14 6 no APD 2 P

SLE: Ext C/S K AC I/L OD OS An entry wound of BB WNL pellet lateral to the inferior lid Temporal Clear sub conjuctival hemorrhage WNL FORMED WNL

-1 restriction in upward gaze with no pain in all gazes and no diplopia

Color fundus photo

Optic nerve photo

CT scan of orbit: BB pellet is within the right orbit in between the superior and medial rectus muscles in the superior medial aspect. It is superior and medial to the optic nerve.

Superior rectus BB Medial rectus Optic nerve CT scan of orbit: BB pellet is within the right orbit in between the superior and medial rectus muscles in the superior medial aspect. It is superior and medial to the optic nerve.

OS OD Superior altitudinal defect OD

Assessment and plan n 14 y/o white male with BB pellet in right posterior orbit and superior visual field defect. n Plan- broad spectrum antibiotics Observe

- - The term “BB” originated from the size of steel balls used in a shotgun of the same size. It has been around from 1900 and refers to guns any operating mechanisms used for air gun.

n Retrospective case review of forty patients with intraorbital foreign bodies were reviewed. Ophthalmology 2002; 109: 494– 500 © 2002

Optic Nerve Transection in Monkeys May Result in Secondary Degeneration of Retinal Ganglion Cells Lekovitch et al. Investigative Ophthalmology & Visual Science, April 2001, Vol. 42, No. 5

Thank You