Bilateral complete blindness following globe‑sparing single‑bullet orbital injury.

ABSTRACT

Traumatic optic neuropathy due to missile injury typically results in unilateral visual loss.[1] We discuss an uncommon case, in which injury from retroocular passage of a single bullet resulted in bilateral orbital perforations, frozen globes, and complete blindness. A 20‑year‑old female presented with bilateral absent light perception detected immediately, following alleged accidental bullet injury. There were no cranial manifestations and sutured skin wounds were visible on the temporal aspects of both the orbits. Bilateral ocular coats were intact with normal intraocular pressure and anterior segments. However, there was bilateral complete afferent pupillary defect and vitreous hemorrhage. Noncontrast computerized tomography (NCCT) imaging revealed multiple orbital and nasal fractures, a bony fragment abutting the right globe [Fig. 1a], and bilateral temporal orbital perforations on reconstructed images [Fig. 1b and c]. The entry wound was left‑sided and slightly lower than the right‑sided exit wound [Fig. 1b and c]. Sonography revealed attached bilateral retinas. The combination of complete afferent and efferent neural dysfunction was attributed to injury of bilateral posterior orbits near the apical region. No ocular intervention was planned due to poor prognoses and absence of any foreign body.