Delayed Orbital Apex Syndrome Caused by a Wooden Chopstick

Abstract

Purpose: We report a case with delayed presentation of orbital apex syndrome caused by the intraorbital retention of a wooden chopstick fragment.Method: Case report.Result: A 51-year-old schizophrenic man was jabbed with a wooden chopstick in his left eye. Two weeks later, his left eye developed orbital apex syndrome. Magnetic resonance imaging (MRI) suspected orbital cellulitis associated with a foreign body. The patient refused any explorative surgery. After therapy with cephalexin followed by prednisolone, his vision and ocular movement improved temporarily. Three months later, painful orbital cellulitis with progressive visual loss occurred. Computed tomography (CT) showed a remarkable contour of the chopstick fragment. Eventually, the patient agreed to undergo explorative orbitotomy and a 2-cm-long tip of the wooden chopstick was removed. The patient recovered well after surgery.Conclusion: In orbital penetrating injuries, chopsticks with dentiform tips have an increased tendency to snap and remain in the orbit. If patients present with delayed onset of neurological signs, retention of intraorbital foreign bodies should be suspected, and adequate imaging should be performed. Surgical intervention is imperative to remove any retained foreign body to prevent delayed complications.