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Show Journal of Clinical Neuro- ophthalmology 9( 1): 61-<; 2, 1988. Neuro- anatomical Feature Photo © 1988 Raven Press, Ltd., New York Near- Miss of the Optic Nerve from a Deep Penetrating Orbital Injury with a Kitchen Knife Mark Volpicelli, M. D., and Ahmad M. Mansour, M. D. A 30- year- old man was assaulted with a kitchen knife, resulting in several stab wounds to the chest and the right orbitofacial region. He presented to the emergency room with a metallic foreign body protruding 5 cm from his right cheek shortly following the incident ( Fig. 1). Examination revealed a broken serrated blade below the infraorbital rim. Visual acuities were 20/ 25 in the right eye and 20/ 20 in the left eye. The pupils were normally reactive, with no afferent pupillary defect. Motility of the right eye was limited in upward and downward gaze. No evidence of globe perforation was found, and indirect ophthalmoscopy was unremarkable. Skull x- rays revealed a serrated kitchen knife positioned upward through the right maxillary sinus roof and through the orbit, posteriorly reaching the right superior orbital fissure ( Figs. 2 and 3). FIG. 1 From the Department of Ophthalmology, University of Texas Medical Branch, Galveston, Texas, U. S. A. Address correspondence and reprint requests to Dr. Ahmad M. Mansour, Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX 77550, U. S. A. 61 FIG. 2 FIG. 3 62 M. VOLPICELLI AND A. M. MANSOUR , FIG. 4 \,,, 1 8, No. 4. 1988 Computed tomography ( CT) scan of the head and orbits revealed intact globes with absence of intracranial penetration by the metallic foreign body. The tip of the knife was abutting on the right optic foramen by the CT scan ( Fig. 4). Under general anesthesia, the foreign body was extricated by gently pulling the blade out with sterile Craftsman pliers. Repeat eye examination was unchanged. Forced duction tests revealed no limitation of the extraocular muscles. The wound was closed primarily. The patient was placed on antibiotics, and his hospital course was unremarkable. He was asymptomatic after 1 month of follow- up and maintained a visual acuity of 20/ 20 in the right eye, with normal motility and funduscopy. |
