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)     

晶状体内异物合并原发性孔源性视网膜脱离一例

患者,男,52岁,工人。因工作时右眼被铁屑溅入自觉异物感伴视物模糊2 d后就诊。眼部检查：右眼视力0.5（矫正视力不提高）,左眼1.0。右眼结膜无充血,角膜中央可见约2 mm大穿通伤口,伤口已自闭,前房深,Tyn（-）,瞳孔等大等圆,晶状体内可见一枚金属异物嵌顿于前囊膜下,部分突出于晶状体前表面,异物周围晶状体皮质混浊（见图1A）。玻璃体混浊,散瞳后眼底见颞上方视网膜青灰色隆起,未波及黄斑,颞上方赤道前可见1枚约1/3 PD大圆孔,视盘界清（见图1B）。左眼角膜透明,前房（-）,瞳孔等大等圆,晶状体透明,玻璃体混浊,散瞳后眼底见颞上方可见格子样变性,视盘界清,视网膜平伏。右眼眼压17 mmHg （1 mmHg=0.133 kPa）,左眼16 mmHg。眼及眼眶CT：右眼晶状体异物（见图1C）。右眼B超：右眼玻璃体腔内可见点状及条状中高回声,可见视网膜脱离光带（见图1D）。诊断：右眼角膜穿通伤、右眼晶状体异物、右眼外伤性白内障、右眼孔源性视网膜脱离。     

Primary Pleomorphic Liposarcoma of the Orbit: A Case Report

To our knowledge, pleomorphic liposarcoma (PL) of the orbit has only been reported in the literature four times. This rarity makes it more difficult to diagnose and to treat in this clinical setting. A 62-year-old female presented with pruritus, edema, proptosis and diplopia 5 months OS. Imaging revealed an intraorbital mass displacing the globe, with infiltration into the sinus. The tumor was removed and the histological examination revealed a highly cellular tumor with heterogenous histology, with a few vacuolated cells and many malignant features. Immunohistochemistry allowed for the differential diagnosis, resulting in a diagnosis of PL of the orbit. The cells were immuno-positive for S-100 and negative for all other relevant markers. According to the literature, prognosis for this neoplasm is quite poor, and exenteration represents the best treatment option. The patient refused exenteration and radiation therapy, however, at 2 year follow-up, she remained recurrence-free.     

内源性鼻疽诺卡菌眼内炎一例

患者,男,67岁。因“左眼突然眼痛、视力下降伴同 侧头痛10 d”于2019年12月30日在厦门大学附属厦门眼科 中心就诊。患者3个月余前四肢及躯干无明显诱因出现斑 块状皮下淤血（见图1）,就诊于当地医院,诊断为“过敏性 皮炎”,自诉涂抹“藏药”治疗2 个月后缓解（用药情况不 详）。近期患者体质量减轻约10 kg,常感乏力、头晕,病因不明。既往有高血压病、糖尿病以及肾病病史数年,药物 控制基本稳定。有青霉素、磺胺类药物过敏史。无眼部外伤史及手术史。眼部检查：矫正视力为右眼1.0,左眼手动/ 眼前10 cm。眼压：右眼14.4 mmHg（1 mmHg=0.133 kPa）, 左眼14.8 mmHg。左眼混合性充血,睫状压痛明显,角膜轻度水肿,少许色素性角膜后沉积物;前房深度正常,房水轻度浑浊,Tydnall（+）;瞳孔欠圆,直径约3.5 mm,部分后粘连。瞳孔区晶状体前囊见少许色素沉着,晶状体灰白色混浊,眼后节红光反射未见（见图2）。     

Angioleiomyoma of the Ciliary Body ： A Case Report

Angioleiomyomaisabenignsmoothmuscletumororiginatingfrombloodvessels.Itcanoccurinallpartsofthebodyincludingorbit.Tothebestofourknowledge,ithasnotbeenreport鄄edintheciliarybodyintheliterature.Onlyasmallnumberofleiomyomaoftheciliarybodywerepresented[1鄄6].Sowepresenthereinacaseofangioleiomyomaoftheciliarybodydiagnosedbypathohistologicandimmunohistochemicalex鄄aminationinourcenter.MaterialandMethod1.CaseA32鄄year鄄oldmanwasreferredtousonOctober27,1999witha4鄄monthhistoryofgrad鄄ualdecreaseinvisi…     

Missed Diagnosis of an Intraorbital Foreign Body of Homemade Fireworks Origin: A Case Report

Purpose

We report a rare case of traumatic injury to the eye caused by homemade fireworks in a Chinese juvenile patient with a metal ring left in the orbit after having been sutured at the Emergency Department.

Methods

An 11-year-old boy presented with a traumatic injury to the right eye from homemade fireworks. Following initial assessment involving maxillofacial computed tomography (CT) and suturing at the Emergency Department, he was transferred to our department for further evaluation because of his poor sight 1 day later. On examination, a skin laceration beneath the right eyebrow was noted, but the superior orbit was not fully visible on the maxillofacial CT performed 1 day previously. Therefore, an orbital CT scan was carried out on the second day, which showed a hyperdense ring embedded in the superior border of the orbital wall; the ring was surgically removed. On postoperative day 7, a fundus examination revealed resolving vitreous hemorrhage, blunt traumatic retinal detachment, and a large retinal tear superior to the macula. The patient refused to take surgery for retinal detachment into consideration. Therefore, we opted for oral steroids and careful observation.

Results

After 2 months’ observation, the large retinal tear had healed and white fibrous scar tissue had developed, and the retinal detachment superior to the macula had reattached itself spontaneously. The patient''s vision had further improved to 20/200. During 1 year of follow-up, he remained clinically stable.

Conclusion

To avoid missing the diagnosis, a complete history of the mechanism of injury and accurate imaging still prove most useful. Complete removal of the foreign body by the emergency physician is necessary because of the ocular toxicity of an iron-containing foreign body. As evidenced by the current case, oral steroids and observation for a period of several months is a management of choice for traumatic retinal detachment and retinal tear superior to the macula associated with homemade fireworks in children.Key Words: Homemade fireworks, Maxillofacial and orbital trauma, Orbital foreign body, Retinal detachment