PROJECTILE METALLIC FOREIGN-BODIES IN THE ORBIT - A RETROSPECTIVE STUDY OF EPIDEMIOLOGIC FACTORS, MANAGEMENT, AND OUTCOMES

Purpose: Intraorbital projectile metallic foreign bodies are associate d with significant ocular and orbital injuries. The authors sought to evaluate epidemiologic factors, the incidence of associated ocular and orbital injury, and the nature and necessity of surgical intervention in these cases. Methods: Charts of all patients with projectile intra orbital metallic foreign bodies seen at our institution (27) over the preceding 7 years were evaluated with respect to age, sex, type of inj ury, associated ocular and orbital injuries, location of the projectil e (anterior, epibulbar, or posterior), postinjury visual acuity, and s urgical intervention. Results: The majority of patients were male, bet ween the ages of 11 and 30, and had BB pellet injuries. Thirteen proje ctiles were lodged anteriorly, 4 were in an epibulbar position, and th e remaining 10 were posterior to the equator. Twelve of 13 anterior, a nd 4 of 4 epibulbar foreign bodies were removed surgically, whereas on ly 2 of 10 posterior foreign bodies required surgery. No case of surgi cal intervention resulted in a decrease of visual acuity. Associated o cular injuries were both more common and severe in patients with poste riorly located foreign bodies. Final visual acuity was better at prese ntation and at discharge in patients with anteriorly located foreign b odies. Conclusion: Intraorbital projectile metallic foreign bodies can be a source of significant ocular morbidity. Management of these case s is dependent on the location of the projectile. Ancillary radiograph ic studies can be helpful. Surgery to remove the projectile should be considered in each case, but foreign bodies that are not readily acces sible often may be left safely in place. Closer regulation of the pell et gun industry, with an emphasis on education and protective eyewear use, would be helpful in reducing these injuries.