BACKGROUND: Ejection injuries involving the eyes have become uncommon due to effective protection by helmets and visors. We report a unique case of intraocular lead foreign body injury occurring after ejection from a Hawk aircraft in a pilot who had his helmet and visor on.CASE REPORT: A 40-yr-old male pilot sustained facial injuries after ejection from a Hawk aircraft. He had multiple foreign bodies embedded in the skin around his jaw, corneal foreign bodies, and self-sealed corneal and lens entry in left eye, with one foreign body lodged within the lens and two in the vitreous behind the lens. The foreign bodies showed low reflectivity on CT scan suggestive of plastic. However, spectroscopic and electron microscopic analysis of pieces removed from the cornea confirmed the material to be predominantly lead, which came from the miniature detonator cord (MDC). An electroretinogram (ERG) showed reduction of scotopic b wave amplitude in the affected eye. The pilot underwent intravitreal foreign body removal successfully through pars plana vitrectomy. Post-removal vision recovered from 20/60 to 20/20 with ERG also showing recovery of scotopic b wave amplitude from 100 μV to 180 μV.DISCUSSION: Though systemic toxicity due to high blood levels of lead are well known, this case is unique in demonstrating direct retinal toxicity because of intravitreal lead foreign body. It also raises aeromedical concerns about the hazards of MDC splatter despite full protection with helmet and visor.Khan MA, Gaur D, Murthy PC, Pandey A. Lead intraocular foreign body injury following ejection. Aerosp Med Hum Perform. 2020; 91(8):673-677.