Transorbital Brain Injury by a Sharp Object: A Case Report and Literature Review.

Non-missile penetrating head injuries are rare in Western countries and often present significant management challenges. We describe the case of a 39-year-old man who sustained a transorbital penetrating brain injury after an assault with a sharp object. On admission, he presented with ocular trauma and impaired consciousness. Computed tomography revealed a metallic object entering through the right orbit, traversing to the left parasagittal occipital bone, with associated intraventricular and subarachnoid hemorrhage. The foreign body was surgically removed without intraoperative complications, followed by ocular enucleation and dural repair. His condition gradually improved, and he was discharged with a Glasgow Coma Scale score of 11. At the one-month follow-up, he demonstrated preserved lower limb strength with mild residual left upper limb paresis, and is currently under rehabilitation. This case highlights the rarity and complexity of orbitocranial penetrating injuries, underscoring the importance of timely diagnosis, careful surgical planning, and multidisciplinary management to optimize functional outcomes.