Purpose: To describe facial gunshot injuries with orbital involvement, their management considerations, and highlight good practice recommendations from the literature.
Methods: Observational case report of three consecutive cases presenting to a single tertiary referral institution and literature review.
Results:Each of the three cases of facial gunshot injury presented with a different pattern of ophthalmic involvement. Common to each case was the need for multi-disciplinary co-management of each patient due to the complex array of associated craniofacial injuries. Case 1 sustained a shotgun injury at 2 metres with multiple pellet scatter injuries, including penetrating eye injury, orbital fractures and pellets within the superior orbital fissure. Case 2 presented emergently following shotgun injury to the midface but with no clear history. A single penetrating wound was event on the left nasal bridge, medial to the nasojugal fold. CT imaging identified the presence of bilateral intra-orbital metallic foreign bodies abutting the medial aspect of the left globe and nasolacrimal duct and at the right orbital apex in proximity to the superior orbital fissure and optic nerve. The serum lead content was elevated. Case 3 presented to the ophthalmology outpatient department five years following a self-inflicted submental gun shot injury, seeking opinion on secondary reconstruction of the left sided orbital anatomy to treat persistent epiphora and undesirable cosmesis. The left eye had no light perception due to pellet fragments within the optic nerve yet the globe was intact.
Conclusion: A multitude of bony and soft tissue ophthalmic injuries may occur following gunshot due to the variability of tissue injury caused by projectiles, based on their trajectory, kinetic energy, and tissue interaction. Following initial resuscitation, stabilisation' and assessment, a hierarchical approach is required in the management of ophthalmic injuries. A multi-disciplinary, patient-centred approach is required to develop an individualised management plan for each patient.