Lei Chaoyu, Li Yinwei, Zhou Huifang, Zhong Sisi
State Key Laboratory of Eye Health, Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
State Key Laboratory of Eye Health, Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
BMJ Case Rep. 2025 Jul 8;18(7):e265477. doi: 10.1136/bcr-2025-265477.
A male in his early 40s presented with a penetrating orbital injury after a nine-centimetre lead sinker was propelled into his right orbit while fishing. He reported pain, ptosis and visual acuity reduced to light perception. X-rays, preferred over CT due to metallic artefacts, revealed the sinker in the inferior orbital fissure with an intact eyeball. Initial surgical extraction attempts triggered a severe vagal response, necessitating endoscopic navigation for safe removal. Postoperatively, despite an intact globe, he developed vitreous haemorrhage and retinal detachment, requiring vitrectomy and silicone oil injection. Three months later, his visual acuity improved to 20/200, with normal blood lead levels. This case emphasises selecting imaging based on foreign body material, avoiding blind extraction using advanced tools if needed, monitoring for intraocular complications and assessing systemic toxicity risks.
一名40岁出头的男性在钓鱼时，一枚9厘米长的铅坠射入其右眼眶，导致眼眶穿透伤。他自述疼痛、上睑下垂，视力降至仅存光感。由于存在金属伪影，相较于CT，X线检查显示铅坠位于眶下裂，眼球完整。最初的手术取出尝试引发了严重的迷走神经反应，因此需要通过内镜导航进行安全取出。术后，尽管眼球完整，但他出现了玻璃体积血和视网膜脱离，需要进行玻璃体切除术和硅油注射。三个月后，他的视力提高到20/200，血铅水平正常。该病例强调应根据异物材质选择影像学检查，必要时避免使用先进工具盲目取出，监测眼内并发症并评估全身毒性风险。
