Emergency Management of Pediatric Orbital Pencil Trauma Outside the Operating Room: A Case Report

Abstract

Penetrating orbital injuries in pediatric patients are rare but potentially vision- and life-threatening emergencies. We present the case of a three-year-old girl who arrived at the emergency department with a penetrating orbital pencil injury. The foreign body was successfully removed under general anesthesia in a minor procedure room, following established non-operating room anesthesia (NORA) safety protocols. This case highlights the critical importance of rapid interdisciplinary coordination, meticulous preoperative assessment, and safe anesthetic conduct in non-traditional environments. Implementation of NORA principles in emergency trauma care can ensure timely intervention while maintaining perioperative safety standards in resource-limited or high-demand settings.

Keywords: non-operating room anesthesia; nora; orbital injury; pediatric trauma; penetrating foreign body; remote location anesthesia.

Figure 1. Patient with a pencil lodged in the right medial orbital region.

Figure 2. Intraoperative management under general anesthesia in NORA settings.

The child is seen under general anesthesia with endotracheal intubation and standard ASA monitors attached. The procedure was conducted in a minor operating room following NORA safety protocols. A multidisciplinary team prepared for controlled removal of the penetrating orbital pencil. NORA: non-operating room anesthesia.

Figure 3. Extracted foreign body.

The wooden pencil removed from the medial orbital region is displayed post-extraction. It clearly shows the dimensions and structure of the pencil, highlighting its sharp tip and length, which reflect the potential depth of penetration and risk to the orbital structure.

Figure 4. Postoperative recovery after foreign body removal.

The patient is seen in the immediate postoperative period under observation following successful removal of the orbital pencil. She is breathing spontaneously. No signs of ocular hemorrhage or neurological compromise were noted.