Man Shot in Eye Survives and Doesn't Lose Vision: A Case Study

11-30 OPH bullet
A bullet to the head is not always as lethal as it may sound. Photo courtesy of The JAMA Network

A gunshot wound to the head is often a death sentence, but a new case study released November 30 described a patient who not only survived such a wound but also retained his eyesight.

The study, now published online in JAMA Ophthalmology Clinical Challenge, described a 45-year-old male patient who was shot in the face with a .22-caliber pistol and lived to tell the tale. According to the report, the bullet passed through a wooden door before entering the patient's right orbital, also known as the eye socket. The bullet tore through the corner of the patient's eye, damaging the tear ducts and coming to rest against a muscle that controls eye movement.

Despite the wound, the patient still had normal pupil responses to light in the injured eye. However, the bullet remained lodged inside the patient's head and was a cause of significant pain.

"This case is rare in that the bullet lodged in the orbit and did not pass into the intracranial cavity," Reza Vagefi, one of the operating surgeons and an associate professor of ophthalmology at UCSF School of Medicine told Newsweek. "Also just as surprising, and lucky for the patient, the eye remained intact and did not rupture. This is not typical and very rare for a bullet to not harm the eye."

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Often, when metallic objects become lodged around the eye, it may be better to leave the foreign object there then attempt to remove it. For example, the study reported that only 5 percent of all patients go on to develop long-term complications from having metallic objects left in their eye cavity.

Air and BB gun pellets are likely to not cause significant damage to the eye because they are small and have minimal velocity. However, bullets, which are larger and travel far faster, usual cause significant damage to the eye. In this case, the wooden door slowed down the bullet's velocity enough so that it did not cause significant damage to the eye and surrounding tissue.

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Due to this particular patient's significant pain, the operating doctors choose to remove the bullet and to repair damage to the tear ducts. The operation, called an orbitotomy, involves removing masses in or around the eye. It is usually used to remove tumors as to prevent them from spreading further. In some cases, such as this, the operation is also used to treat foreign objects lodged in the eye socket.

Though eye injuries are common, gun shots to the head are not the number one cause of eye injury. According to a 2015 report on the topic conducted by the American Academy of Ophthalmology, falling down the stairs is the most common cause of injury.

The patient went on to have no surgical complications and his pain was reduced following the bullet's removal. Amazingly, his eyesight was in no way affected by the experience.