Finkelstein M, Legmann A, Rubin P A
Ophthalmic Plastics and Orbital Surgery, Massachusetts Eye and Ear Infirmary, Boston 02114, USA.
Ophthalmology. 1997 Jan;104(1):96-103. doi: 10.1016/s0161-6420(97)30355-8.
Intraorbital projectile metallic foreign bodies are associated with significant ocular and orbital injuries. The authors sought to evaluate epidemiologic factors, the incidence of associated ocular and orbital injury, and the nature and necessity of surgical intervention in these cases.
Charts of all patients with projectile intraorbital metallic foreign bodies seen at our institution (27) over the preceding 7 years were evaluated with respect to age, sex, type of injury, associated ocular and orbital injuries, location of the projectile (anterior, epibulbar, or posterior), postinjury visual acuity, and surgical intervention.
The majority of patients were male, between the ages of 11 and 30, and had BB pellet injuries. Thirteen projectiles were lodged anteriorly, 4 were in an epibulbar position, and the remaining 10 were posterior to the equator. Twelve of 13 anterior, and 4 of 4 epibulbar foreign bodies were removed surgically, whereas only 2 of 10 posterior foreign bodies required surgery. No case of surgical intervention resulted in a decrease of visual acuity. Associated ocular injuries were both more common and severe in patients with posteriorly located foreign bodies. Final visual acuity was better at presentation and at discharge in patients with anteriorly located foreign bodies.
Intraorbital projectile metallic foreign bodies can be a source of significant ocular morbidity. Management of these cases is dependent on the location of the projectile. Ancillary radiographic studies can be helpful. Surgery to remove the projectile should be considered in each case, but foreign bodies that are not readily accessible often may be left safely in place. Closer regulation of the pellet gun industry, with an emphasis on education and protective eyewear use, would be helpful in reducing these injuries.
眶内投射性金属异物常伴有严重的眼和眼眶损伤。作者旨在评估这些病例的流行病学因素、相关眼和眼眶损伤的发生率以及手术干预的性质和必要性。
对过去7年在我们机构就诊的所有眶内投射性金属异物患者（27例）的病历进行评估，内容包括年龄、性别、损伤类型、相关眼和眼眶损伤、投射物位置（前部、眼球表面或后部）、伤后视力以及手术干预情况。
大多数患者为男性，年龄在11至30岁之间，受伤原因是气枪铅弹。13枚投射物位于前部，4枚在眼球表面，其余10枚在赤道后方。13枚前部和4枚眼球表面异物中有12枚和4枚通过手术取出，而10枚后部异物中只有2枚需要手术。没有手术干预导致视力下降的情况。后部异物患者的相关眼损伤更常见且更严重。前部异物患者就诊时和出院时的最终视力更好。
眶内投射性金属异物可导致严重的眼部疾病。这些病例的处理取决于投射物的位置。辅助影像学检查可能会有帮助。应考虑对每个病例进行手术取出投射物，但难以触及的异物通常可安全地留在原处。加强对气枪行业的监管，重点是教育和使用防护眼镜，将有助于减少这些损伤。
