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A 15-year-old boy presented with an inability to open his left eye after being assaulted with a pencil. A small laceration was noted on the left eyebrow (Panel A). An ophthalmic examination revealed no light perception; a fixed, dilated pupil; complete ptosis; complete ophthalmoplegia; a medial subconjunctival hemorrhage; and a normal fundus. The orbital apex syndrome was suspected, and emergency computed tomography showed a large pencil fragment penetrating the medial orbit, with its tip in the cranial cavity (Panel B). The central graphite component of the pencil is radiopaque, whereas the surrounding wood structure is radiolucent. A four-vessel angiogram revealed . . . [Full Text of this Article] |
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