Girl initially presents with open globe injury

The ophthalmology service was consulted for an otherwise healthy 6-year-old girl who was hit in the right eye by her brother with a pen 3 days before presenting to the emergency room. The patient’s mother thought her daughter seemed fine immediately after the event. However, over the next few days, the child complained of increasing irritation in her right eye. The mother took a closer look and was alarmed when she saw a “brown bubble” on the right eye.On exam, the patient’s visual acuity was 20/70 in the right eye and 20/25 in the left eye. In the right eye, the pupil was peaked at 7 o’clock with iris prolapsing from a full thickness scleral laceration near the limbus. The anterior segment of the left eye was unremarkable. Fundus exam was deferred until surgery due to the patient squeezing, given the open globe injury. A CT scan of the orbits showed no intraocular metallic foreign body. She was then taken to the operating room that night for urgent repair of the open globe.