Abstrakt
The authors present an unusual case and clinical case report of a 21 year old patient who sustained a penetrating gunshot injury of his head (and both orbits). The left eye was dislocated in front of the eyelids and heavily damaged.
The right eye looked normal. The place where the bullet entered the scull was located near the temporal margin of the right orbit, the exit wound was close to the temporal margin of the left orbit.
After the accident the patient was conscious but his visual functions were not examined. The patient was consequently given sedatives and intubated.
After his transportation to the hospital, he has undertaken several procedures under a complex intensive care and continual sedation. These included primary enucleation of the left eye, reconstruction of the margin of the left orbit and bilateral revision of the medial area of the orbits with the removal of bone fragments.
After the completion of all imaging examinations there was no other pathology found except for the penetration wound of both orbits and ethmoid bones. The ophthalmoscopy could not be evaluated due to a heavy bleeding into the vitreous.
The ultrasound examination revealed a heavy traumatic damage of the posterior segment of the eye and therefore a reconstructive surgery (pars planavitrectomy) was indicated. However, during the surgical intervention the avulsion of nerve fibres from the neuroretina was diagnosed and the state was classified as further unsolvable.