Gunshot orbital wounds

Four cases of orbital gunshot wounds are described in this article. The first patient attempted suicide. The bullet crossed his right orbit and ethmoidal sinus and stopped in his left ethmoidal sinus, partially penetrating in the left orbit. The right eye had no light perception because of an undirect optic neuropathy. The second patient was shot during a war by a sniper in his left orbit. His left eye had no light perception because of a total retinal detachment-the bullet had remained deep in the orbit. In these first two cases, the projectile was successfully removed by a transconjunctival orbitotomy. The third patient and fourth patient accidently shot themselves several years previously. They both had a severe bilateral traumatic optic neuropathy. Plain X-ray films and coronal and axial computed tomography scan with bone window are the most effective imaging techniques in foreign body location and orbital, bulbar, and cranial damage evaluation. Foreign body removal should be always considered because of local and general reactions caused by lead and copper; but intraoperative projectile localization may result unexpectedly difficult. Early medical treatment of traumatic optic neuropathies is advised.