Removal of intraconal bullet through endoscopic transnasal surgery with image-guided navigation system 8 months after injury: a case report

BACKGROUND: Lodgment of a bullet within the orbit is uncommon. The decision to remove these objects poses a challenge to surgeons due to a high risk of complications. Currently, endoscopic transnasal surgery with navigator assistance facilitates the localization of foreign bodies allowing their safe removal with minimal surrounding tissue damage or optic nerve injury. CASE PRESENTATION: We describe a case of a 26-year-old Thai woman with a chronic intraorbital foreign body located within her medial intraconal space. The chronic intraorbital foreign body was successfully removed by endoscopic transnasal surgery, combined with assistance from a navigation system, 8 months after injury without any damage to her eye or disturbance in vision. CONCLUSION: Intraconal foreign bodies, such as bullets, are a chronic problem and should be observed in the long term; prompt surgical removal should be performed if indicated.