without facedown position. Ophthalmology 2005; 112: 1222–1226. 3 Martinez-Castillo V, Verdugo A, Boixadera A, Garcia-Arumi J, Corcostegui B. Management of inferior breaks in pseudophakic rhegmatogenous retinal detachment with pars plana vitrectomy and air. Arch Ophthalmol 2005; 123: 1078–1081. 4 Ung T, Comer MB, Ang AJ, Sheard R, Lee C, Poulson AV et al. Clinical features and surgical management of retinal detachment secondary to round retinal holes. Eye 2005; 19: 665–669. MP Snead, P Alexander, A Ang and A Poulson Vitreoretinal Service and Vitreoretinal Research Group, Ophthalmology Department, Cambridge University NHS Trust, Cambridge, Cambridgeshire, UK E-mail: mps34@cam.ac.uk Eye (2009) 23, 1233–1234; doi:10.1038/eye.2008.172; published online 6 June 2008 Sir, Management of perforating globe injury from a nail gun with intraocular C3F8 Ocular trauma is the leading cause of monocular blindness worldwide 1 and intraocular foreign bodies (IOFBs) are a major contributor accounting for approximately 17–41% of cases. 2 We present an unusual trauma case, whereby C3F8 gas escaped into the orbit resulting in surgical emphysema. Case report A 37-year-old man had an accidental perforating injury while using a pneumatic nail gun in the left eye. Examination revealed hand movement (HM) acuity, a 3.8 mm corneal laceration, shallow anterior chamber with hyphema (0.5 mm), iris sphincter tear, and anterior lens capsule disruption with temporal dislocation of the lens. Owing to vitreous haemorrhage, fundus examination was not possible but retinal detachment was excluded on orbital ultrasound. Figure 1a (X-ray) demonstrates the close proximity of the IOFB to the superior orbital roof. The patient underwent a three port pars planar vitrectomy (PPV) with lensectomy. The nail had perforated the retina inferotemporal to the disc and was pulled out through the corneal wound revealing a gaping round hole at the posterior pole. During IOFB removal, a self-limiting suprachoroidal haemorrhage (SCH) developed inferiorly. The eye was subsequently filled with 14% C3F8 gas to tamponade the posterior retinal defect and the patient was asked to posture face down. At the first postoperative day, 60% gas fill was detected but on the third day only 10% gas fill remained with surgical emphysema evident on the left upper lid (Figure 1b). The surgical emphysema and SCH gradually resolved and a month later, his best-corrected acuity was 10/200 and a retinal defect was evident with surrounding subretinal haemorrhage and retinal folds due to retinal incarceration (Figure 2). Figure 1 (a and b) Lateral orbital radiograph showing the nail in close proximity to the superior orbital roof (a) and surgical emphysema in the upper lid (b; arrow). Figure 2 Fundus photograph showing a retinal defect inferotemporal to the disc with surrounding subretinal haemor- rhage and retinal folds. Correspondence 1234 Eye