SAVING THE EYE: MANAGING A DEVASTATING PERFORATING OCULAR TRAUMA

To present the urgent surgical management and outcome of a devastating perforating ocular trauma caused by a high-velocity metallic foreign body.

University Eye Hospital Ljubljana, Slovenia

A 31-year-old man suffered a severe injury to the right eye when a metal fragment struck the globe during metal pressing. On admission, visual acuity was no light perception and ocular hypotony was present. Slit-lamp examination revealed a full-thickness corneal laceration from limbus to limbus with prolapsed intraocular tissue. Computed tomography of the head showed a disrupted globe and a 22x7 millimetres metallic foreign body located posterior to the eye. Immediate primary repair with repositioning of ocular tissue and corneal suturing was performed, followed by removal of the orbital foreign body the next day.

The postoperative course was stable under systemic and topical antibiotic therapy and tetanus prophylaxis. Although visual recovery was not achieved, the globe integrity was successfully preserved.

Devastating perforating ocular injuries with metallic foreign bodies demand rapid, well-coordinated surgical management. Early wound closure and staged removal of the foreign body are essential to prevent infection and preserve the anatomical integrity of the globe — even when visual recovery is not possible.