Shotgun pellets in the cavernous sinus

We present two cases of ocular shotgun injury where pellets entered the cavernous sinus. Both injuries occurred accidently while shooting pheasants. The first patient developed a third nerve palsy, while the second developed a third and a sixth nerve palsy. In each case, CT scanning showed a pellet in the cavernous sinus. Both recovered completely within four months. In both cases, only one pellet had lodged in the orbital area and had entered medial to the globe causing only minor ocular contusions before entering the cavernous sinus. Shooting is well recognised as a dangerous pastime and reports of associated ocular injuries abound in the literature. In both our cases, the entry wound was in the medial canthal area; we postulate that pellets at this location are funnelled along the medial orbital wall, through the superior orbital fissure and into the cavernous sinus. We could find only one other reference describing a pellet in the cavernous sinus.