Transcript BB Gun Injury - University of Louisville Ophthalmology

Grand Rounds
Amir R. Hajrasouliha, M.D.
University of Louisville
Department of Ophthalmology and Visual Sciences
Thursday, December 5th, 2014
Patient Presentation


CC: BB gun shot in the face
HPI: 14 y/o male, previously healthy boy, was out
at his friends house playing with BB gun. Friend
pointed the gun and accidentally shot him in the
right corner of the right eye from 3 feet away.
Patient complained of mild blurred vision and pain
in the eye movement. He denied any double vision.
Patient Presentation

PMH:
ADHD (attention deficit
hyperactivity disorder)

POH:
None

Meds:
Methylphenidate

Allergies:
None
Exam
VA
(n,sc)
20/25
20/20
Tp
25
P
6
4
6
2
14
no APD
SLE:
Ext
C/S
K
AC
I/L
OD
OS
An entry wound of BB
WNL
pellet lateral to the inferior lid
Temporal
Clear
sub conjuctival hemorrhage
WNL
WNL
FORMED
FORMED
WNL
WNL
-1 restriction in upward gaze with no pain in all gazes
and no diplopia
Color fundus photo
Optic nerve photo
CT scan of orbit: BB pellet is within the right orbit in between the superior and
medial rectus muscles in the superior medial aspect. It is superior and medial
to the optic nerve.
Superior
rectus
BB
Medial
rectus
Optic
nerve
CT scan of orbit: BB pellet is within the right orbit in between the superior and
medial rectus muscles in the superior medial aspect. It is superior and medial
to the optic nerve.
OS
OD
Superior altitudinal defect OD
Assessment and plan

14 y/o white male with BB pellet in right
posterior orbit and superior visual field defect.

Plan- broad spectrum antibiotics
Observe
-
-
The term “BB” originated from the
size of steel balls used in a shotgun of the same
size.
It has been around from 1900 and refers to guns
any operating mechanisms used for
air gun.

Retrospective case review of forty patients with
intraorbital foreign bodies were reviewed.
Ophthalmology 2002;109:494–500 © 2002
Optic Nerve Transection in Monkeys May Result in Secondary
Degeneration of Retinal Ganglion Cells
Lekovitch et al. Investigative Ophthalmology & Visual Science, April 2001, Vol. 42, No. 5
Thank You