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A 5-year-old boy activated an air-pressure pistol from a distance of about 10 cm, pointing directly toward his right eye. Examination revealed downward vertical deviation of the right eye and emphysema of the eyelid and conjunctiva (Panel A). Visual acuity of the right eye was reduced to 20/80. Computed tomography disclosed the presence of intraorbital, extraocular air (arrow, Panel B), which expanded to the optic nerve and to intracranial structures. No soft-tissue lesions or traumatic fractures were identified. After two weeks, all the morphologic and functional lesions had disappeared, and visual acuity of the right eye had increased to 20/20. This case may suggest that the optic canal is a pathway to the brain.
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