A 12-year-old male presented to the Emergency Room after he sustained trauma to his right eye (OD) with paintball bullet.
He was not wearing the safety goggles. On examination, his best corrected visual acuity BCVA was 20/80 in right eye (OD) and 20/20 left eye OS, intraocular pressure was 23 mmHg OD and 24 mmHg OS. Left eye examination was within normal limit.
Slit lamp examination showed subconjunctival hemorrhage with sticky white matters, corneal epithelial defect and mild cornea haze with no signs of globe rupture. Anterior chamber was deep with dispersed hyphema, and the pupil was regular and reactive with no afferent pupil defect. Posterior segment was not clear because of cataract.
Ultrasound B-Scan showed no eye wall defects but mild choroidal detachment and flat retina.
The patient started on topical prednisolone acetate 1% 4 times a day for the first week and then it was tapered and topical cyclopentolate 1% drops 3 times a day was prescribed for the first 2 weeks, and requested to have complete bed rest. Two days later, his vision dropped which was due to corneal edema with Descemet's folds and the cataract changes. Iris showed sphincter ruptures, and Ultrasound B-Scan was repeated and confirmed flat retina. Six weeks later he was found to have corneal scar and dense cataract for which he underwent cataract examination and intraocular lens implantation with the final BCVA 20/50.