Intraorbital foreign body: clinical presentation, radiological appearance and management

Abstract

Intraorbital foreign bodies usually occur after a high velocity injury such as gunshot or industrial accidents; more rarely they occur following trivial trauma. A retained foreign body can give rise to serious complications, the most devastating of which is loss of the eye. This retrospective, interventional case report reviews the clinical features, radiological appearance and surgical management of two patients who presented at Sultan Qaboos University Hospital, Oman with intraorbital foreign bodies. Details of ocular history, preoperative ocular examination findings including visual acuity, surgical procedure and subsequent management were noted. The two patients, aged 10 years and 9 years old respectively, sustained orbital trauma with sharp objects. Both patients were found to have intraorbital foreign bodies that were documented clearly by computed tomography (CT) scans of the orbit. The first patient presented straight after injury, had no ocular involvement, underwent immediate surgical exploration and ended up with full recovery. The second patient presented to us after a delay of 4 days, and was found to have endophthalmitis. This patient ultimately lost all visual function in the affected eye. A CT scan is the modality of choice for orbital foreign body detection and localization. Early surgical exploration and foreign body extraction greatly influence the visual prognosis and final outcome.

Keywords: Case report; Eye Injuries, penetrating; Oman.

Figure 1.1:

Pre-operative face photos show moderate lid ptosis, normal position of the globe in primary gaze, and conjunctival hyperemia in left eye (1.1b), with marked limitation in adduction and abduction (1.1 a and c)

Figure 1.2:

Computed tomography (CT) images of the orbits - Axial CT images through the orbits show: a) High density linear foreign body (straight arrow) within the medial rectus muscle of the left orbit; b) The medial rectus muscle is enlarged due to a hematoma. The distal tip of the foreign body is seen against the medial wall of the orbit (arrow head)

Figure 1.3:

Foreign body (fish bone), the larger piece is 2.5cm, the shorter is 2.0cm

Figure 1.4:

Face photo of same patient three days after intraorbital foreign body removal. Lid edema and ptosis are reduced (1.4b). Patient has mildy restricted adduction and abduction (1.4 a and c)

Figure 1.5:

Two weeks post-operatively, the left eye looks normal in the primary position (1.5b). Patient has recovered normal adduction and abduction (1.5 a and c)

Figure 2.1:

Photo of the right eye pre-operatively. It shows a swollen lower eyelid and an arrow pointing at possible location of foreign body in the lower lid

Figure 2.2:

Computed tomography (CT) images of the orbits - Axial CT images through the orbits show: a) High density linear foreign body (straight arrow) within the medial rectus muscle of the left orbit; b) The medial rectus muscle is enlarged due to a hematoma. The distal tip of the foreign body is seen against the medial wall of the orbit (arrow head)

Figure 2.3:

Foreign body: pencil tip, measuring 0.5 cm at its widest dimension

Figure 2.4:

Face photo after foreign body extraction. The swelling has subsided and the wound has healed completely, leaving no deformity