Rationale: Orbitocranial penetrating injuries can accidentally occur in children while handling pencils and can cause severe sequelae such as ocular damage, brain lesion, intracranial haemorrhage, and infections. Patient Concerns: We report the case of a 7-year-old child with an orbitocranial penetrating injury by a pencil, initially gone undetected, that caused a direct damage to the optic nerve. Diagnosis: Computed tomography scan with contrast detected the foreign body and the presence of a lesion of the left internal carotid artery. Treatment: Angiography was performed to treat the vascular lesion and to prevent haemorrhage. Subsequently, a craniotomy was performed to assist the extraction of the pencil from the entry wound and to remove residual fragments. Outcomes: Left eye vision was lost. The 1-year follow-up was uneventful. Take-away Lessons: Operative angiography is mandatory before the surgical extraction of the orbitocranial penetrating injury in case of documented intracranial vessel damage.