The authors report a case of head injury by a bullet of a Winchester, caliber 22. The examination, made five months later, showed blindness of the left eye and severe neuroparalytic keratitis in the right eye which presented also a convergent strabism and a complete involvement (motor and sensitive) of the right trigeminal nerve. A detailed X-rays examination failed to reveal any fracture and the metallic dust showed a tangential lesion over the tip of the pyramid surface. The left eye was enucleated and replaced by a protectic eye. A blefarorraphy was done in the right side in order to improve the corneal conditions. Indeed, there was an almost complete regression of the keratitis. The authors study the several etiologic causes of the tip of the pyramid syndrome and emphasize the rarity of traumatic etiology. Finally, they comment the different clinical aspects of this case.