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Reminder of important clinical lesson
A minor lid laceration concealing a potentially life-threatening injury


A 29-year-man presented with an injury to his left upper lid, having stumbled onto the tip of a pool cue. He presented with minimal signs and symptoms, initially thought as a minor lid laceration and was managed with lid suturing. Two months later, he presented with vertical diplopia on upward gaze and showed a picture consistent with traumatic Brown’s syndrome. Subsequent imaging revealed the extent of orbital injury and confirmed a retained foreign body embedded in the frontal lobe of the brain. This was surgically removed and found to represent the tip of the pool cue. Postoperatively, the patient made a good recovery, although he still has a slight residual diplopia on upward gaze.

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