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Intraoperative use of C-arm fluoroscope for removal of gun pellet in the orbit

Gun pellet injury is rare but devastating to the eye. Airgun pellets made of lead can ricochet between the orbital bony walls and can damage the intraocular structures, even causing loss of vision. These pellets can get displaced in the orbital fat during surgical manipulation. Intraoperative CT scan is not readily available in hospitals; however, C-arm fluoroscopy is readily available in most setups. We used a C-arm fluoroscope and three instruments (i.e., two malleable retractors and a periosteal elevator) for locating and removing the pellet successfully in two cases, which to the best of our knowledge has not been reported before.