J Korean Ophthalmol Soc.  2009 Mar;50(3):462-466. 10.3341/jkos.2009.50.3.462.

A Case of High-Pressure Paint Gun Injury to the Eyeball and Ocular Adnexa

• Moon HJ
• You IC
• Yoon KC

• KMID: 2111259
• DOI: http://doi.org/10.3341/jkos.2009.50.3.462

Abstract

PURPOSE: To report a case of high-pressure paint gun injury to the eyeball and ocular adnexa.
CASE SUMMARY
A 50-year-old woman was admitted after accidental high-pressure paint injection to her right eye while working. She complained of pain and severe swelling of the eyelids covered with paint. Slit lamp biomicroscopy showed multiple conjunctival lacerations, deposition of paint material on her conjunctiva, corneal edema and crystalline lens dislocation. Orbital computed tomography revealed infiltration of paint material into the retrobulbar space and rupture of medial rectus muscle. The paint was removed from the conjunctiva, Tenon's tissue, and medial orbit after the medial rectus muscle was disinserted. On the second postoperative day, the wound was irrigated and pus was drained from the conjunctiva wound. Two months after the operation, the patient underwent cataract removal due to high intraocular pressure associated with lens dislocation. Six months after the operation, eyeball movement was improved except medial gaze, and the cornea was stable with moderate corneal haziness.
CONCLUSIONS
In high-pressure paint gun injury to the eye, detail evaluation, prompt removal of the foreign body and proper management of complications are necessary.

Keyword

Eyeball; High-pressure; Paint gun injury

MeSH Terms

Cataract
Conjunctiva
Cornea
Corneal Edema
Dislocations
Eye
Eyelids
Female
Foreign Bodies
Humans
Intraocular Pressure
Lacerations
Lens Subluxation
Lens, Crystalline
Middle Aged
Muscles
Orbit
Paint
Rupture
Suppuration

Figure

• 

  Figure 1. Preoperative findings. (A, B) Anterior photography showed corneal edema with Descemet membrane folding, lens dislocation, and green-colored paint materials on the right eyelid (A) and conjunctiva (B). (C) Computed tomography demonstrated multiple radiolucent materials in the right conjunctiva and retrobulbar space. (D) Ultrasound sonography revealed dislocated lens and multiple hyperechoic lesions in retrobulbar space of the right eye.

• 

  Figure 2. Intraoperative findings. (A) Green paint materials (arrow) were visible in the medial intraconal space and medial rectus muscle. (B) Computed tomography revealed a drainage tube (arrow) and remnant foreign bodies along medial rectus muscle.

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  Figure 3. Findings at 6 months after operation. (A) Gaze limitation improved, except medial gaze in the right eye. (B) The cornea was stable with moderate haziness.

Reference

References

1. Fialkov JA, Freiberg A. High pressure injection injuries: an overview. J Emerg Med. 1991; 9:367–71.

2. Dallas NL. Chronic granuloma of the orbit caused by grease-gun injury. Br J Ophthalmol. 1964; 48:158–9.

3. Boukes RJ, Stilma JS, de Slegte RG, Zonneveld FW. Grease-gun injury of the orbit: computed tomography and magnetic resonance imaging in diagnosis and treatment. Doc Ophthalmol. 1987; 67:273–80.

4. Yip CC, Tan DT, Balakrishnan V, Choo CT. High-pressure paint gun injury to the orbit and ocular adnexa. Int Ophthalmol. 1998; 22:335–9.

5. Goel N, Johnson R, Phillips M, Westra I. Grease gun injuries to the orbit and adnexa. Ophthal Plast Reconstr Surg. 1994; 10:211–5.

6. Fineman MS. Ocular paintball injuries. Curr Opin Ophthalmol. 2001; 12:186–90.

7. Fineman MS, Fischer DH, Jeffers JB, et al. Changing trends in paintball sport-related ocular injuries. Arch Ophthalmol. 2000; 118:60–4.

8. Liu D, Al Shail E. Retained orbital wooden foreign body: a surgical technique and rationale. Ophthalmology. 2002; 109:393–9.

9. Kuhn F, Morris R, Mester V. Potato gun ocular injury. Opht-halmology. 1998; 105:1796–7.

10. Barker-Griffith AE, Streeten BW, Abraham JL, et al. Potato gun ocular injury. Ophthalmology. 1998; 105:535–8.

11. Nasr AM, Haik BG, Fleming JC, et al. Penetrating orbital injury with organic foreign bodies. Ophthalmology. 1999; 106:523–32.

12. Vilke GM, Snyder B. High pressure paint spray gun injury. J Emerg Med. 2002; 23:203–4.

13. Hogan CJ, Ruland RT. High-pressure injection injuries to the upper extremity: a review of the literature. J Orthop Trauma. 2006; 20:503–11.

14. Rosen WJ, Campbell DG. Posterior capsule rupture after a paint- pellet injury. J Cataract Refract Surg. 2000; 26:1422–3.

15. Gekeler F, Cruz AA, de Paula SA, et al. Intraconal grease-gun injury: a therapeutic dilemma. Ophthal Plast Reconstr Surg. 2005; 21:393–5.

16. Holds JB, Patrinely JR, Zimmerman PL, Anderson RL. Hydraulic orbital injection injuries. Ophthalmology. 1993; 100:1475–82.

17. Thach AB, Ward TP, Hollifield RD, et al. Ocular injuries from paintball pellets. Ophthalmology. 1999; 106:533–7.

18. Ramirez-Ortiz MA, Vasquez-Resendis A. Isolated bilateral posterior scleritis after eye trauma. J AAPOS. 2007; 11:284–5.

19. Greven CM, Bashinsky AL. Circumstance and outcome of ocular paintball injuries. Am J Ophthalmol. 2006; 141:393.

20. Lee YH, Lee JE, Kim SS, et al. A Case of subconjunctival oil granuloma caused by a high pressure injection injury by bunker fuel oil C. J Korean Ophthalmol Soc. 2005; 46:2095–9.

21. Duma SM, Ng TP, Kennedy EA, et al. Determination of significant parameters for eye injury risk from projectiles. J Trauma. 2005; 59:960–4.

22. Baath J, Ells AL, Kherani A, Williams RG. Severe retinal injuries from paintball projectiles. Can J Ophthalmol. 2007; 42:620–3.

23. Taban M, Taban M, Sears JE. Ocular findings following trauma from paintball sports. Eye. 2008; 22:930–4.

24. Mason JO 3rd, Feist RM, White MF Jr. Ocular trauma from paintball-pellet war games. South Med J. 2002; 95:218–22.

25. Hargrave S, Weakley D, Wilson C. Complications of ocular paintball injuries in children. J Pediatr Ophthalmol Strabismus. 2000; 37:338–43.

26. Farr AK, Fekrat S. Eye injuries associated with paintball guns. Int Ophthalmol. 1998-1999; 22:169–73.

27. Kruger LP, Acton JK. Paintball ocular injuries. S Afr Med J. 1999; 89:265–8.

28. Mirzayan R, Schnall SB, Chon JH, et al. Culture results and amputation rates in high-pressure paint gun injuries of the hand. Orthopedics. 2001; 24:587–9.