We present the case of a patient with a transethmoidal penetrating injury to the contralateral orbital apex and optic nerve. Orbital apex fractures can be broadly classified as linear (not displaced), comminuted (with fragment displacement), and apex avulsion.1 The neurovascular anatomy of the orbital apex is complex, and injuries involving this area, directly or indirectly, can have different clinical outcomes. Numerous syndromes have been described depending on the combination of clinical findings. Clinical symptoms and signs do not always correlate with the degree of trauma or radiological findings. The neurovascular structures could be severely traumatized without an orbital apex fracture being present.
Computed tomographic image of a plastic pen lodged in the left orbit of our patient. The pen has an appearance similar to that of air on computed tomography. A bony spicule appears in relation to the optic nerve on the right side.
The external Lynch-Howarth approach.
The plastic pen has been advanced to the laceration on the lateral canthus of the left eye for removal.
The plastic pen after removal from the left orbit. The scale on the top half of the ruler is in centimeters.
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