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

2. Patient Presentation CC: BB gun shot in the face CC: BB gun shot in the face 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. 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.

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

4. Exam VA Tp P VA Tp P(n,sc) no APD no APD 20/2525 14 20/20 6 4 6 2

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

6. -1 restriction in upward gaze with no pain in all gazes and no diplopia

7. Color fundus photo

8. Optic nerve photo

9. 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.

10. BB Superior rectus 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.

11. OS OD Superior altitudinal defect OD

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

13. - The term “BB” originated from the size of steel balls used in a shotgun of the same size. 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. air gun.

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

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

21. Thank You