Nerf Gun Injury: Fractured Intra-Ocular Lens

To present a case of ocular trauma from a nerf gun injury resulting in the fracture of an single piece intra-ocular lens

Single case report

A 48-year-old gentleman presented to the ophthalmology emergency eye unit following a traumatic injury to the left eye. He stated that three days prior to the presentation, he was shot in the left eye with a nerf gun by his son at approximately 2-3 metre distance. The patient had a complicated ocular history in the affected eye with a previous penetrating eye injury aged 9 which underwent primary repair and a previous retinal detachment aged 21 which was repaired with cryotherapy and a scleral buckle. He also underwent lens exchange in his late 30’s.  

The clinical examination of the affected eye showed that the visual acuity was 6/6, there was conjunctival hyperaemia, central corneal bullae with mild corneal oedema and an irregular pupil with aniridia. The anterior chamber was deep with cells 3+, pigment 2+, flare 1+. Intraocular pressure was 41mmhg and the IOL was stable. However, it was noted that there was a defect in the IOL where the haptic was fractured. On fundus examination there was pigment in the vitreous, mild commotio retinae and a localised retinal detachment which was supported by the previous scleral buckle.

The patient responded well to the above treatment with the visual acuity remaining stable at 6/6 and the intra-ocular pressure reducing on topical medication to 10 mmhg. The anterior chamber was deep and quiet, the IOL was fractured but centred and stable and the commotio retinae resolved.

Ocular trauma is one of the leading causes of preventable blindness and visual damage. The world health organisation (WHO) prevention of blindness reported that globally, over 55 million eye injuries occur each year with three quarters of a million people requiring hospitalisation.

This case highlights the impact these devices have on the eye and the fracture of the single piece intraocular lens, which has not previously been reported.  We recommend that the inclusion of protective eyewear be mandatory in all foam dart devices to improve ocular safety and compliance and help prevent potentially serious ocular damage and visual impairment from happening.