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Mr Shuttleworth and Mr Galloway (August 2001 JRSM, pp. 396-399) record the devastating effects of airgun injuries to the eye. Otorhinolaryngologists also encounter such injuries. We presented a series of three cases previously1; since then two more have been seen. Included in the series was a 14-year-old boy who, whilst walking with a friend along one of the canals in West Bromwich, Birmingham, felt a sudden sharp pain in the left eye. At the time, he was unaware that he had been shot. On arrival at home his father noticed bleeding from his left eye. He was taken to Sandwell District Hospital and a pellet was shown lodged in the right sphenoid sinus. The eye was damaged and had to be removed. The pellet was extracted from the sphenoid sinus. The path of the pellet was through the left eye, left ethmoid sinuses, through the cartilagenous nasal septum (creating a permanent hole) and nose. The pellet ricocheted off the right lateral wall of the nose and lodged in the right sphenoid sinus having entered the sinus through its anterior wall.
The perpetrator of this injury was found to be a 9-year-old boy playing unsupervised with an airgun. We agree with Shuttleworth and Galloway that more measures need to be taken to avoid such injuries, but we think the best way is through raising public awareness.
Another important point to discuss is: remove or leave the pellet? A further case dealt with since this report was of a patient who had had a pellet lodged in her face (on the anterior surface of the maxillary sinus) for well over 30 years. When she was a child whilst walking with her elder sister in a park in West Bromwich, she felt a sudden sharp pain in her cheek. Blood was found tracking from a small wound on the cheek and nothing much was done about this at the time. After more than 30 years there was a reunion between the two sisters attending their mum's funeral, and the younger sister was prompted to seek advice. An X-ray showed a pellet lying on the anterior surface of the maxillary sinus. Blood lead concentration was not raised. Personally, I favour removal of lodged pellets, and this was done.