Occult intraorbital BB presenting as unilateral pigmentary retinopathy

Abstract

A 7-year-old boy presented with unilateral pigmentary retinopathy in the right eye. Best-corrected visual acuity was 20/200, and a relative afferent pupillary defect was noted. Fundus examination revealed sectoral retinal pigment epithelial changes involving the peripapillary, macular, and inferior peripheral retina. The patient and family denied any history of trauma to the orbit or projectile exposure. Over a year later, he presented with left-sided orbital cellulitis. An orbital computed tomography scan incidentally revealed a 6 mm metallic foreign body consistent with a BB along the posterior and inferior aspect of the right globe. This case underscores the importance of maintaining a high index of suspicion for trauma even in the absence of reported injury, especially in children.