Orbitocranial wooden foreign body diagnosed by magnetic resonance imaging. Dry wood can be isodense with air and orbital fat by computed tomography.

In computed tomographic (CT) scans, a wooden foreign body can appear as a lucency with nearly the same density as air or fat, and it can be indistinguishable from orbital adipose tissue. Magnetic resonance imaging (MRI) can localize these wooden foreign bodies in the orbit. We studied a case in which a wooden golf tee lodged in the right optic canal of a nine-year-old boy. The head portion lodged in the orbital apex and the tip entered the interpeduncular fossa. Clinical examination revealed a right paranasal laceration; the right eye had no light perception and a peripapillary hemorrhage, but was otherwise normal. Surgical exploration and evaluation by CT failed to locate the foreign body. However, the golf tee was demonstrated by MRI as a low intensity image. Although it was removed by craniotomy with good neurological results, bacterial panophthalmitis led to enucleation of the eye. This case emphasizes the diagnostic value of MRI and the hazards of retained wooden foreign bodies.     

Intracranial foreign body in a globe-perforating injury

CASE REPORT: To report a case with an intracranial foreign body in the setting of a globe-perforating injury. A 53-year-old man experienced a sudden pain in his right eye while he was breaking a stone with a sledgehammer. Upon examination, a 1.5 mm superomedial corneoscleral perforation site was noted. Cranial sections of axial orbital computed tomography (CT) revealed a foreign body at the middle cranial fossa. COMMENTS: A high index of suspicion is required to detect an intracranial foreign body in ocular injuries. Orbital CT must be included in preoperative evaluation of these patients and cranial sections must also be examined carefully.     

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)     

An extraordinary orbital foreign body

The authors report a unique case of a broken motorbike handle that presented as a bilateral orbital foreign body. A 30-year-old male sustained an injury to the right side of his face when he skidded from his motorbike while riding. He had bilateral sudden loss of vision and presented to emergency services with bilateral proptosis, motility restriction, and a right lower eyelid laceration. CT scan revealed a 7-cm-long motorbike handle lodged in the retrobulbar space of both orbits, close to the cribriform plate. Left lateral orbitotomy was performed to remove the foreign body; the right eye regained normal vision and function. The unique features of this case include the nature of the foreign body, its bilateral location, its proximity to the optic nerve and cribriform plate, and the challenges in its removal. The clinical presentation and management is presented, along with the surgical video.     

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.     

Isolated lateral rectus myositis as a manifestation of idiopathic orbital inflammation

BACKGROUND: We report the case of of a patient with isolated, acute, monolateral and monomuscular lateral rectus myositis as a manifestation of a localized, nonspecific, idiopathic orbital inflammation. HISTORY AND SIGNS: A 25-year-old man presented to our clinic with a painful right eye and associated double vision on right gaze due to a limitation of abduction. Conjunctival hyperemia was observed in the area of the right lateral muscle insertion. A slight axial proptosis of the right eye was evident. On axial CT scans a fusiform enlargement of the right lateral rectus muscle including a thickened anterior tendon at its insertion was recorded. A thorough systemic and laboratory investigation showed neither any further abnormal findings nor any systemic disease. THERAPY AND OUTCOME: A monocular, monomuscular myositis as a clinical manifestation of idiopathic orbital inflammation was diagnosed by the clinical findings and imaging with orbital CT/MRI scans. By appropriate treatment with oral steroids slowly tapered over weeks, symptoms and signs showed full remission without any complications. Clinical improvement was observed within a few days after the beginning of steroid administration. CONCLUSIONS: Isolated lateral rectus myositis can be a manifestation of idiopathic orbital inflammation. Diagnosis is made by the clinical presentation and imaging with orbital MRI/CT-scans. Other local or systemic inflammatory, endocrine or neoplastic diseases must be ruled out.     

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     

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.     

Orbital Involvement in Systemic Mastocytosis

Abstract

A 61-year-old female presented with a 3-day history of painful and reddened right eye with painful ocular movements. She had been diagnosed as having systemic mastocytosis 4 years earlier. Ocular examination showed Best Corrected Visual acuity of 6/6 right eye and 6/6 left eye. There was marked conjunctival injection and chemosis. The posterior segment was normal. The left eye was normal. Exophthalmometry showed 2?mm of right proptosis relative to the left eye. Computed tomography (CT) scans showed an ill-defined intra-conal lesion and enlargement of the lacrimal gland in the right orbit. A diagnostic biopsy was performed; the histopathology findings were of orbital mastocytosis. We present what our literature search suggests is the first biopsy-proven case of orbital mastocytosis.     

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)     

A case of Pantoea endophthalmitis

A previously healthy 50-year-old man was transferred to our hospital for evaluation of acute inflammation in his right eye after ocular trauma while using a grass mower. Slit lamp examination showed 1 mm-length full thickness corneal laceration without leakage, 4+ cells and inflammatory membrane in the anterior chamber, 10% hypopyon, posterior synechiae formation, and cataract change. Upon orbital computerized tomography, a metallic intraocular foreign body in the lens was identified. Vitrectomy, phacoemulsification, foreign body removal, anterior chamber irrigation, and intravitreal antibiotics injections of vancomycin and ceftazidime were performed. In a culture of humor from the anterior chamber grew Pantoea species. More procedures were performed, including intravitreal antibiotics injection of ceftazidime. Upon administering a course of intravenous ceftazidime, fortified ceftazidime and moxifloxacin eye drops, and oral prednisolone, the patient improved.     

Intraorbital wood foreign body: a case study

A 12-year-old child had left orbital trauma by wood. He consulted 4 months after for orbital cellulitis with cutaneous fistula. The CT scan showed the presence of a left orbital wood foreign body extended to the homolateral cavernous sinus and intracranial. Extraction of the wood fragment associated with an adapted antibiotic treatment led to clinical improvement without visual recovery. A situation of orbital trauma and secondary orbital inflammatory syndrome must raise the suspicion of a foreign body of the orbit and motivate emergency imaging for optimal management of the disorder.     

Melanocytoma of the ciliary body

CLINICAL CASE: We report the case of a 25 year old woman who attended our Hospital with a pigmented lesion in anterior chamber angle of her right eye. She complained of reduced visual acuity on the same eye. On examination, and once complementary tests were performed, a pigmented lesion located on the iris root and ciliary body of her right eye was confirmed. A decision to perform a local resection was made and there were no surgical complication. Histology results confirmed the diagnosis of ciliary body melanocytoma. DISCUSSION: Ciliary body melanocytoma is a benign rare lesion with only 40 cases described in the literature. A local resection of this benign lesion should be considered as alternative to enucleation, even though differential diagnosis with malignant melanoma must also be considered.     

精神病患者巨大眶内异物1例

患者,男,39岁,以右眼红、痛入院。他受到一个老者暗示将自己的右眼用木棒击伤。临床表现为右眼中度突出,完全性眼肌麻痹和严重眶周皮肤肿胀。眼科影像学表现为右眼眼窝蜂窝组织炎及眼下静脉血栓形成,两侧海绵窦综合征和海绵窦血栓。报告中无眼内及眶内异物。积极使用静脉抗生素,患者的病情并没有得到改善。在麻醉下检查发现在穹窿下有一个巨大的木质异物。异物去除及强力抗生素治疗下患者病情明显恢复。诊断中发现受伤原因可能是由这个精神病患者自我伤害引起。详细的病史、检查及合理的调查揭示其潜在的病因。敏锐的察觉及相关的临床发现与影像学研究在眶内异物及眶蜂窝组织炎处理中显得尤为有效的。及时诊断和治疗可能进一步减少患者的发病率或死亡率。     

Orbital osteoma arising adjacent to a foreign body

A 27-year-old man sustained a blast injury to the face in April 1996, with a resultant foreign body at the right medial orbital wall. He refused to undergo surgical removal of the foreign body at that time and was discharged on oral antibiotics. Five years later, he presented because of recurrent attacks of swelling, redness, and pain at the right medial canthal area. A repeat computed tomography (CT) scan revealed fragmentation of the original orbital foreign body and an adjacent radiodense lesion that appeared to blend smoothly with the orbital bone from which it arose. This lesion was not present on the initial CT scan done 5 years earlier immediately following the blast. The patient was started on oral antibiotics and surgical exploration was carried out. Three fragments of the foreign body were removed in addition to the adjacent orbital lesion, which proved to be an ivory-type osteoma on histopathology. We briefly review previously suggested factors in the pathogenesis of osteoma and present further evidence in favor of both traumatic and infectious factors.     

眼眶植物性异物的诊断和治疗

目的：通过对眼眶植物性异物的临床分析，该病最好的诊断和治疗方法。方法：复习我院收治的眼眶植物性异物21例,分析其各项检查及治疗方法。结果：眼眶瘘管形成占眼眶植物性异物的57．14％；B型超声检查异常者占64．70％，可提示异物存在者占41．18％；CT扫描异常者94．12％，可提示异物存在者占41．18％；2例行MRI检查均清晰地显示出异物影像，21例患者均手术取出异物，证实术前诊断。结论：眼眶植物性异物影像学检查显示率较低，对于显示异物，MRI优于超声和CT。正确诊断必须结合病史和眼部体征，尤其是眼眶瘘管的存在，手术摘出异物的同时需将瘘管一同切除，以求彻底治愈。     

Ethmoidal osteoma with intraorbital extension: excision through a transcutaneous paranasal incision

PURPOSE: To describe a case of conjunctival hyperaemia and proptosis of the right eye. METHODS: Three-dimensional computed tomography (CT) was performed to reveal the size and position of a lesion of osseous density extending into the right orbit. The lesion was then excised using a right paranasal transcutaneous approach. RESULTS: The pathology report suggested ethmoidal osteoma. The postoperative course was uncomplicated and the lesion did not recur during a 5-year follow-up period. Repeated postoperative ophthalmic examinations revealed preservation of visual acuity and visual fields postoperatively. DISCUSSION: Diagnosis is based on imaging studies, especially CT and three-dimensional CT scans. A three-dimensional CT scan is critical in understanding the actual dimensions of the tumour and its relations with other structures. Surgical removal is indicated in cases with orbital matrix compression and displacement. A transcutaneous paranasal approach allows for increased exposure of affected structures.     

Adenoid cystic carcinoma arising in the inferior orbit without evidence of lacrimal gland involvement

A 60-year-old woman sought treatment for right orbital fullness and intermittent headache. CT revealed an inferior orbital mass along the inferior rectus muscle. Incisional biopsy revealed an adenoid cystic carcinoma. Orbital exenteration followed by concurrent radiotherapy and chemotherapy was performed. The lacrimal gland was uninvolved by tumor microscopically. Although rare, adenoid cystic carcinoma must be considered in the differential diagnosis of an orbital tumor, because the unusual location of an orbital adenoid cystic carcinoma may make its early detection difficult.     

A case of microphthalmos with cyst and partial trisomy 22

A 13-day-old girl was referred for evaluation of a right orbital mass. Ophthalmic examinations revealed microphthalmia with cyst in the right eye and microphthalmia in the left eye. She had low-set ears, auricular fistula, micrognathia, and muscular hypotonia. Chromosomal analysis using fluorescence in-situ hybridization (FISH) showed partial trisomy 22. To our knowledge, microphthalmos with cyst associated with partial trisomy 22 has not been described previously in the English literature. Repeated aspiration resulted in a decrease in size of the cyst.     

Cervical carcinoma metastatic to the orbit

PURPOSE: To describe a case of orbital metastasis from an undifferentiated pelvic tumor with probable cervical origination. METHODS: Case report. Detailed ophthalmologic examination, orbital CT and MRI, and orbital biopsy with histologic and immunohistochemical analysis. RESULTS: A 29-year-old woman with a history of untreated cervical dysplasia was hospitalized with flank pain, hematuria, and abnormal vaginal bleeding. Biopsy of a large mass, protruding from the cervix as a grape-like cluster, had cellular morphology and immunohistochemical staining patterns consistent with cervical cancer. Diplopia in downgaze developed shortly after hospitalization. Ophthalmic examination was notable for mild right lower eyelid fullness, 1.5 mm right relative proptosis, and a deficit in supraduction and infraduction of the right eye. Orbital MRI and CT revealed a 1.2 x 1.6-cm mass immediately inferior and posterior to the right globe without bone involvement. On biopsy, the mass had histology similar to that of the pelvic tumor. On metastatic workup, lesions were found involving the left femoral head, liver, and spinal column, with adjacent lymphadenopathy. Despite treatment with radiation and chemotherapy, the patient died several months later of causes related to the systemic disease. CONCLUSIONS: Orbital metastasis of cancer originating in the cervix, despite its rarity, should be considered when an orbital mass of unknown cause is present.