Orbital foreign body masquerading as conjunctival melanoma 60 years after injury

A 74-year-old man presented with a 6-month history of a pigmented conjunctival lesion on his left eye. The lesion was initially suspicious for conjunctival melanoma. The patient admitted to a remote history of trauma from a airgun pellet over 60 years ago. Anterior examination revealed a 6 x 6 mm pigmented left conjunctival lesion and B-scan of the lesion was suggestive of a retained orbital foreign body. The lesion was removed through a transcaruncular medial orbitomy and pathology showed a retained orbital foreign body. A newly pigmented conjunctival lesion although initially concerning for melanoma represented a retained orbital body that surfaced many years after the initial orbital trauma.     

Reactivation of Thyroid Associated Orbitopathy Following Trauma with Intraorbital Foreign Body

A 63-year-old female with mild, bilateral, stable thyroid-associated orbitopathy sustained trauma resulting in glass foreign bodies embedded on the left ocular surface and left lateral orbital extraconal and intraconal space. After 2 orbitotomies including a failed attempt to remove the intraconal foreign body and poor response to oral steroids, she developed severe, progressive left periorbital edema and 9?mm of relative proptosis. Serial, post-operative imaging demonstrated worsening inflammatory changes along the surgical tract, which slowly improved over several months, with simultaneously worsening proptosis and enlargement of the left inferior and medial rectus muscles consistent with worsening thyroid orbitopathy. She subsequently underwent unilateral 3-wall orbital decompression with improvement in her symptoms. Periorbital trauma with orbital foreign bodies and related surgical trauma may result in reactivation of thyroid-associated orbitopathy.     

Orbital wooden foreign body

A 76-year-old-female patient fell in her garden, inducing a right orbital wound in which no foreign body was primarily found. As pain and diplopia followed the orbital trauma, a CT-scan was performed, disclosing a linear external foreign body in the right orbit. An anterior orbitotomy was performed to remove an 18-mm-long wooden foreign body. Histopathology of the tissue surrounding the foreign body showed an inflammatory fibrous tissue with small granulomas around telluric particles. Improvement after the operation was dramatic with complete disappearance of diplopia the day following surgery. Antibiotics were prescribed and tetanus prophylaxis was performed.     

Anaerobic orbital abscess secondary to intraorbital wood

A case of anaerobic orbital cellulitis secondary to intraorbital wood and an approach to management are presented. Retained foreign bodies should be suspected in all penetrating orbital injuries involving wood. Computed tomography (CT) should be performed to delineate the location and size of any foreign body and to determine damage to adjacent structures. Magnetic resonance imaging (MRI) is useful in certain circumstances. Orbital infection should be anticipated and broad-spectrum antibiotic cover (including anaerobes) provided. Surgical intervention should be undertaken to remove any retained foreign bodies to prevent vision-threatening complications.     

The use of intraoperative fluoroscopy as an aid for removal of radiopaque intraorbital foreign bodies

Two patients with orbital trauma and intraorbital foreign bodies, as seen on a computed tomography scan, were taken to the operating room to rule out occult ruptured globe with possible foreign body removal. The C-arm fluoroscopic unit was employed to obtain real-time images of the foreign body's location in relation to the surgeon's dissection tools and the foreign body was extracted with minimal dissection and operating time. When removal of a foreign body is warranted, intraoperative fluoroscopy can help reduce surgical time and orbital manipulation.     

Orbital helical computed tomography in the diagnosis and management of eye trauma

OBJECTIVE: To prospectively determine the accuracy of helical computed tomography (CT) and multiplanar reconstruction and its value in surgical planning for the management of ocular trauma with suspected intraocular and orbital foreign bodies using surgical and clinical follow-up findings as the gold standard. DESIGN: Prospective, observational case series. PARTICIPANTS: Thirty-six patients with ocular trauma and suspected foreign bodies were studied. INTERVENTION: All patients were examined using a standardized scanning protocol with helical CT direct scanning in the axial plane and multiplanar reconstruction of coronal and sagittal planes. MAIN OUTCOME MEASURES: The images were analyzed for the presence and number of intraocular and orbital foreign bodies, anatomic location, and foreign body size. The surgical and clinical follow-up findings (contact lens examination, gonioscopy, indirect ophthalmoscopy and scleral depression, perimetry, color testing, measurement of size) were used as the gold standard to which the image results were compared. RESULTS: Helical CT showed a single intraocular foreign body in 14 patients, a single orbital foreign body in 9 patients, and multiple orbital foreign bodies in 2 patients. Intraocular or orbital foreign bodies were excluded in 11 patients. Twenty foreign bodies were correlated with surgical results. Surgical and clinical follow-up findings were in agreement with helical CT results regarding the detection and determination of the number of presumed foreign bodies. Localization to intraocular versus orbital compartment and proximity to the optic nerve was accurate in all patients. Determination of size of the foreign bodies on the helical CT images was reliable and repeatable. CONCLUSIONS: Helical CT axial scanning with multiplanar reconstruction is accurate at detecting and localizing intraocular and orbital metallic, glass, and stone foreign bodies. This imaging method aids the surgeon in choosing the surgical approach to retained intraocular and orbital foreign bodies.     

Perfluoro-n-octane in orbital cavity after posterior vitrectomy and suture of eye perforating injury: case report

A case of a perfluoro-n-octane leakage into the orbital cavity after corneoscleral suture, scleral buckling and pars plana vitrectomy in an eye with perforating injury after trauma is reported for the first time. A previously healthy 39-year-old man was sent for ophthalmic evaluation one day after suffering a penetrating ocular trauma in his right eye while hammering a nail. On the initial evaluation, the patient presented sudden reduction of visual acuity on his right eye with a perforating corneoscleral injury, intraocular foreign body and retinal detachment. The patient was submitted to corneoscleral suture, pars plana vitrectomy with perfluoro-n-octane administration to flatten the retina and scleral buckling, when it was found transfixation of the globe by the intraocular foreign body. Postoperatively, computed tomography scans of the orbit were ordered due to proptosis, which showed the presence of hyperdense images, suggesting leakage of perfluoro-n-octane into the orbital cavity. Thus, in cases of perforating eye injury, one should be suspicious about the possibility of intraocular foreign body, as well as possible occurrence of transfixation of the globe when scheduling the surgery.     

Orbital Trauma with a Large Plant Foreign Body: a Case Report

We report a case of a large plant foreign body in the orbit. A 30-year-old male presented to our hospital 6 h after a penetrating orbital injury in his left superior eyelid when he skidded from his motorcycle while riding. When the patient reported to us, he already had an inability to open his left eye and a continuous pain in the left orbit. On examination, there was a large plant foreign body penetrating the nasal orbit through the left upper eyelid. Orbital CT revealed a low density linear foreign body measuring 3.6 ×0.5 cm in the left orbit.An emergency operation was performed to remove the foreign body. The patient’s visual acuity did not recover satisfactorily due to optic nerve injury.This case highlights the fact that careful surgical removal of foreign bodies is the treatment of choice and that all patients should receive post-operative antibiotic therapy because of the high incidence of secondary orbital infections. The final outcome and prognosis depend greatly upon the composition and location of the foreign body and whether there are serious complications. (Eye Science 2013;.28:44 - 47)     

24例眼眶异物诊断和治疗分析

目的 分析目前眼眶异物诊断和治疗中存在的问题.方法 回顾性系列病例研究.收集2002年5月至2007年5月收治的眼眶异物患者24例,根据其临床和影像学资料了解目前眼眶异物诊断和治疗中存在的问题.结果 植物性异物11例,金属异物6例,玻璃异物2例,其他5例.18例曾行清创缝合术,12例曾行异物取出术,7例曾行3次以上各类手术.诊断和治疗中存在的问题:(1)受伤情况询问不详、对眶内异物存留认识不足;(2)未进行必要的CT检查;(3)不能正确阅读CT片,CT显示异物而未能诊断;(4)急诊清创处理、以及后续的化脓性感染切开引流,均未进行必要的探查;(5)对植物性和塑料异物,仅满足术中取出一个或数个异物;(6)对眼眶解剖结构不熟悉,手术技术不熟练,不能取出异物甚至将其推向深处;(7)再次手术时未重新进行必要的CT检查;(8)麻醉方式选择不当.局部麻醉下,患者不能耐受手术.结论 眼科医师应掌握眶内解剖结构、影像学和眶内异物的诊断,熟悉眼眶手术入路,提高异物取出成功率,减少手术并发症.(中华眼群杂志,2008,44:676-680)     

Posttraumatic cellulitis and ulcerative conjunctivitis caused by Yersinia enterocolitica O:8

A 55-year-old white man presented with orbital cellulitis and suspicion of an intraorbital foreign body after ocular trauma. He underwent orbital exploration, but no intraorbital foreign bodies were identified. Intraoperative orbital and conjunctival cultures grew Yersinia enterocolitica O:8. The patient's signs and symptoms resolved with intravenous antibiotic treatment after this exploratory orbitotomy. This is the first case, to our knowledge, of human orbital cellulitis caused by Y. enterocolitica O:8. The single visible interpalpebral conjunctival ulceration was suspected to be an entry wound by the patient's primary physician, the emergency room physician, and the orbital surgeon prior to surgical investigation, at which time all the other ulcerations were identified. Therefore, the physical manifestations of this rare but important infection are presented because they may mislead clinicians in suspecting an intraorbital foreign body.     

Intraorbital glass foreign body missed on CT imaging

A 36-year-old woman presented with a 7-week history of foreign body sensation in the superior right orbit after orbital trauma sustained during an accidental face-down fall onto a broken drinking glass. CT identified a 10.35 x 3.91-mm radiopaque foreign body in the right orbit superolateral to the globe. Orbital exploration superficial to the levator palpebrae superioris aponeurosis in close proximity to the site occupied by the CT-identified foreign body revealed an additional glass intraorbital foreign body, 4.0 x 2.5 x 0.25 mm in dimension. The second glass foreign body was entirely missed on the preoperative, 1-mm axial scans combined with sagittal and coronal reconstructed images and plain radiography.     

Laceration and partial dislocation of LASIK flaps 7 and 4 years postoperatively with 20/20 visual acuity after repair

PURPOSE: To report two cases of late ocular trauma resulting in laceration of corneal flaps 7 and 4 years (cases 1 and 2, respectively) after LASIK. METHODS: A 49-year-old man sustained laceration of the flap and interface foreign body debris from construction material in the right eye 7 years after uneventful LASIK (case 1). A 33-year-old man had partial dislocation of the flap 4 years after LASIK in the left eye (case 2) due to a penetrating wood chip accident. Surgical procedures were performed to remove the foreign bodies and reposition the flaps. RESULTS: In case 1, postoperative uncorrected visual acuity (UCVA) was 20/25 with manifest refraction of -0.50 -0.50 x 110 corrected to 20/20. In case 2, UCVA was 20/20 with piano refraction after LASIK retreatment. CONCLUSIONS: Corneal LASIK flaps are susceptible to penetrating trauma, which can occur >7 years after the procedure. Proper everamanage ment of the trauma and LASIK flap can restore excellent visual acuity.     

Intraorbital organic foreign body--a diagnostic challenge

Intraorbital organic foreign bodies pose a diagnostic and management challenge to ophthalmologists. A high degree of suspicion of an orbital foreign body is needed when patients present with injuries to the eyelids and orbit. We present a case of retained intraorbital wooden foreign body which was initially undetected. A 10-year-old boy presented to the eye casualty with signs and symptoms suggestive of orbital cellulitis. He was started on intravenous antibiotics and urgent CT of the orbits did not reveal any foreign bodies. There was spontaneous extrusion of a wooden foreign body through the upper lid two days later, followed by spontaneous resolution of symptoms. Wood has a density similar to air and fat and can be difficult to distinguish from soft tissue in both a plain X-ray film and a computed tomogram. Clinicians should be alerted to the possibility of retention of an intraorbital foreign body in all patients presenting with periorbital trauma. The clinician should also obtain a careful history of the type of injury and should examine the patient in detail. In cases where a wooden foreign body is suspected, investigation by magnetic resonance imaging is preferred.     

An intraorbital metallic foreign body

A 30-year-old male presented with diplopia for 20 days post occupational accident involving left side of his nose, while he was working with a nail gun. He was fully conscious and did not have any neurological deficits. Patient narrated the mechanism of injury and was sure that the nail fell down after hitting the left side of his nose. He had normal vision, but extra ocular movements were restricted and painful. Computed tomography (CT) scan revealed a curved metal object lodged in the posterior aspect of the left orbit extending diagonally from medial wall to the anterior-superior aspect of the orbital roof. The object was removed via a small surgical approach, inflicting least possible surgical trauma. Post surgery, the patient recovered with complete resolution of diplopia. The original aspects of this case are the lack of signs of a foreign body entry and its relative harmlessness in spite of its large size.     

Unnoticed Eyelid Foreign Body Presenting as Ptosis

A patient sustained right orbital trauma with unnoticed penetrating injury and a retained eyelid foreign body. She presented six weeks later with a complaint of persistent ptosis. The circumstances surrounding her injury are described, the issues arising and successful management of the case are discussed.     

CT检查在眼外伤中的临床应用价值

目的探讨cT检查在眼外伤中临床应用价值。方法回顾分析52例（84眼）急诊眼外伤的CT检查资料。结果52例（84眼）CT检查均发现异常,包括眶内异物、眼内异物、眶骨骨折、眶内软组织伤、晶状体脱位、晶状体脱出、眼球变形和复合性损伤等。结论CT是眼外伤的首选检查方法,可为临床诊断和手术提供重要依据。     

Bone from an orbital floor fracture causing an intraocular foreign body

PURPOSE: To describe the ophthalmoscopic and radiologic findings of a patient who sustained blunt orbital trauma. A piece of bone from the fractured orbital wall caused an intraocular foreign body. DESIGN: Case report. METHODS: An 18-year-old man underwent full ophthalmoscopic examination 1 week after sustaining blunt ocular trauma to the right eye while playing basketball. B-scan ultrasonography and computed tomography of the orbits were also performed. RESULTS: Visual acuity, intraocular pressure, and anterior segment examination were normal. Funduscopic examination revealed a fragment of bone that had penetrated the sclera, choroid, and retina. A hole in the sclera was visible. No treatment was performed. Three months later, the patient had no ocular complaints or complications as a result of this injury. CONCLUSION: Bone from a patient's orbit may cause an intraocular foreign body that may be followed conservatively in certain circumstances.     

A metallic foreign body presenting in the anterior chamber angle.

PURPOSE: This article describes a case in which a patient presented with a previously undetected metallic foreign body in the anterior chamber angle. METHODS AND RESULTS: A 42-year-old Hispanic man presented with a 5-day history of foreign-body sensation and redness in his left eye. He had been using a hand saw without safety glasses 2 days before the onset of his initial symptoms. Physical examination revealed a metallic foreign body embedded in the inferior angle of his left eye. Surgical removal of the foreign body was performed, and the patient remains well 1 year after surgery. CONCLUSIONS: All physicians should maintain a high degree of clinical suspicion for intraocular foreign bodies when presented with a patient who may have sustained ocular trauma. All eye-care providers need to emphasize the need for proper eye protection to patients who engage in high risk activities that may lead to penetrating ocular trauma.     

A case of retained wooden foreign body in orbit

A 41-year-old man visited our clinic complaining of esodeviation of the right eye. He had been operated on for corneal laceration 3 years before. One month later, exodeviation of the right eye had developed. The result of computed tomography (CT) was reported as orbital abscess and cellulitis. Although antibiotic treatment was administered for 2 weeks, the exodeviation didn't improve. On ocular examinations performed in our hospital in November-2001, his right eye was esotropic and had a relative afferent pupillary defect. Vision of the right eye was decreased to 0.02. Fundus examination showed optic atrophy. A new CT scan disclosed a foreign body introduced into the right medial orbital wall, nasal cavity and ethmoidal sinus. Although foreign body was surgically removed, vision and eye movement were not improved. In the case of a patient who has undergone orbital trauma, complete history taking and physical examinations must be performed. On suspicion of a foreign body, imaging study such as CT or MRI must be performed. However, because CT findings can be variable, careful follow-up is needed.     

眼部弓箭射伤诊治的体会

目的探讨眼部弓箭射伤的手术治疗方法。方法7例（7眼）眼部弓箭伤进行分析。7例眼部巨大异物（箭）分别采用分离软组织后拔出和眼球摘除同时拔出异物（箭）。结果7例均完整取出弓箭异物,不伤及眼球者视力完好,眼球破裂者视力丧失,伴颅脑损伤者有神经并发症。结论眼部弓箭射伤是罕见的眼部巨大异物,需及时手术取出,术前行CT检查,手术的方式根据箭伤及的部位和是否伴有眼球贯通和颅脑伤。