A 15-year-old Apache Indian boy presented to the emergency department stating that he had been shot in the left eye with a BB. He complained of burning in the left eye and a generalized headache. Skull roentgenograms were obtained (Fig 1).
On physical examination, the patient had 20/20 visual acuity by Snellen examination. The left eyelid was edematous and mildly ecchymotic. There was a small blood stain at the inner canthus of the left eye. The globes were intact and extraocular movements were normal. The left anterior nasal septum showed a small amount of fresh oozing blood. Vital signs were stable, and results of the neurologic and physical examinations were otherwise unremarkable.
A computed tomographic scan revealed an intact globe and air in the left orbital wall just medial to the medial rectus muscle. A bony defect was present in the posteromedial wall of the left bony orbit and in