A stone in the orbit: Dramatic pediatric ocular trauma

We report the case of a 15-year-old male who consulted at the ophthalmology emergency department for trauma of his left eye from a stone thrown with a slingshot by his nephew while playing together. He consulted 3 h after the ocular trauma had occurred. The patient reported no medical history. Visual acuity was no light perception for the left eye. The slit lamp exam of the left eye found a white stone visible at the palpebral opening which totally masks and pushes back the eyeball [Figure 1a]. Besides, the examination of the right eye was normal. An orbital computed tomography scan was urgently requested and confirmed the presence of a left intra-orbital foreign body measuring 31 mm × 21 mm in the axial plane with a height of 24 mm [Figure 1b]. This foreign body pushes back the eyeball which is completely collapsed. The patients were informed of the poor prognosis of their left eye and that surgery was needed to remove the foreign body. He was put on antibiotics and analgesics. During the operation, the foreign body (a white pebble) was removed from the orbit. The globe rupture was observed with the impossibility of suturing the ocular structures [Figure 1c]. An evisceration of the left eye was done with the placement of a hydroxyapatite implant to restore orbital volume. The postoperative examination, the day after the surgery, and during the follow-up examinations did not find any signs of inflammation or infection.Figure 1: (a) white stone visible at the palpebral opening which totally masks the eyeball. (b) orbital computed tomography scan showing a left intra-orbital foreign body (white arrow). (c) severe globe rupture was observed after stone removalOcular trauma in children from playing with objects is very catastrophic and is one of the causes of blindness and ocular morbidity. It can lead to loss of vision that can have a very serious psychological impact on a child. According to the World Health Organization, 55 million eye injuries per year result in the restriction of daily activities and, therefore, continue to be a public health problem worldwide.[1,2] Intraocular foreign body (IOFB) is defined as an intraocularly retained, unintentional projectiles it accounts for 16%–41% of ocular injuries.[3] The final visual outcome in patients with intraocular foreign bodies depends on the initial visual acuity, size and location of the IOFB entry wound, size and location of the IOFB entry wound and associated complications such as intraocular hemorrhage and retinal detachment.[4] The main objective of the treatment is to remove the foreign intraocular body, restore ocular anatomy, and treat associated complications.[5] Slingshots or hand catapults are common playthings for children and young teenagers. They can be risky and dangerous to use, as a blow to the eye or orbit can result in significant injuries involving the visual prognosis. Indeed, ocular trauma in children from playing with objects can lead to severe consequences for the eye and loss of vision. This vision loss also has a psychological impact on the child. Therefore, measures should be taken by the parents and caretakers to prevent the occurrence of these ocular traumas, such as monitoring play objects and putting sharp objects out of reach of children. The role of protective glasses should also be considered. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.