What Lies Within?

A Nesting Arrow
‘behind’ The Hyphema: A case report
Veristian Herdy, MD1, Sumanti Eugeni, MD1, Prasetyo Eko, MD, Ph.D2
1
Department of Opthalmology, Faculty of Medicine Sam Ratulangi University, Prof. Dr. R.D.Kandou General Hopital, Manado, North Sulawesi
2
Department of Neurosurgery, Faculty of Medicine Sam Ratulangi University, Prof. Dr. R.D.Kandou General Hopital, Manado, North Sulawesi

To report a patient with profound metallic periorbital-intracranial

Purpose foreign body with no obvious wound and brain injury signs
presented with the right eye (RE) proptotic and hyphema

Case Illustration History taking

• A 15-years-old boy complaining of RE blurred vision since a trauma to his
face 7 days ago
• RE pain and headache
• fully consciousness and unremarkable physical examination
Ophthalmological examination RE
• Visual acuity 1/300
• IOP 5 mmHg
• Hertel Exophthalmometry showed proptosis
• Chemosis and hyphema
• The ultrasound showed vitreous haemorrhage and suspected retinal
detachment with no foreign body

referral
referralto
to
neurosurgeon
neurosurgeonfor for
foreign
foreignbody
bodyremoval
removal
was
wasdone
done

Discussion
• For some reasons patient can be uncooperative. Patient with profound metallic periorbital-
intracranial foreign body, fully conscious, with no obvious wound and brain injury signs and
otherwise unremarkable physical examination can leads us to delayed diagnosis
• The skull x-ray and CT-scan leads to the diagnosis of metallic peri-orbita and intracranial
foreign body
• Every injury is unique, any step-by-step guidelines must be adapted to the situation and
make sure the patient is systemically stable and to get a history of the incident

Conclusion
The initial mandatory assesment for any ocular trauma cases is to determine the nature and
extent of the injury

Keyword hyphema, orbitocranial injury, ocular trauma Reference

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management of hyphema. survey of ophthalmology. 2016 May 1;61(3):297-308.
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challenging disease. European Archives of Oto-Rhino-Laryngology. 2015 May 1;272(5):1157-63.
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departments: 2001–2007. Graefe's archive for clinical and experimental ophthalmology. 2013 Mar 1;251(3):629-3.
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