A 25-year-old male sustained trauma by paintball gun bullet to his left eye (OS) while he was playing a game with no safety goggles. Two days prior to presenting to the Emergency Room, he gave history of losing consciousness at the playing house.
On examination, his best corrected vision BCVA in right eye (OD) was 20/20 and light perception LP in left eye (OS), and intraocular pressure was 12 mmHg in both eyes. Slit lamp examination of right eye was unremarkable. Left eye examination showed lid swelling, subconjunctival hemorrhage, no signs of orbital fracture, full range of extra ocular muscles movements, and hyphema with ruptured sphincter muscles (Fig. 2A) with no clear view to the posterior segment. Ultrasound B-Scan was within normal.
Computed Scan (CT-Scan) for brain and orbits was done and was normal. He was started on hourly topical prednisolone acetate 1% drops and atropine 1% drops three times per day with complete bed rest.
Nine days later his vision improved to 20/70, with trace of microscopic hyphema and flat retina the topical prednisolone acetate 1% drops frequency reduced to every three hours and atropine stopped. He developed dense posterior and anterior sub-capsular cataract (Fig.2B) dropped his vision to the range of 20/200 for which he underwent cataract extraction with posterior chamber intraocular lens with the final BCVA 20/30 and 15 mmHg IOP but with permanent pupil dilation.