Problems in diagnosis and treatment of orbital foreign body-an analysis of 24 cases

Abstract

To evaluate the problems presented in the diagnosis and treatment of orbital foreign body. This was a retrospective case series. We reviewed and analyzed 24 cases of orbital foreign bodies treated by us in the past 5 years. Twenty four orbital foreign body cases were treated by the authors from May 2002 to May 2007. Eleven cases were plant foreign bodies, 6 cases were metallic foreign bodies, 2 cases were glass foreign bodies and 5 cases were other types of foreign bodies. Wound cleaning operations were performed in 18 cases. Foreign body removal surgery was performed in 12 cases. In 7 cases, three or more operations were undertaken. The problems presented in the diagnosis and treatment of orbital foreign body included: (1) History taken was inadequate and failed to recognize the presence of orbital foreign body. (2) The necessary CT examination was not performed. (3) CT films was not read correctly and failed to detect the orbital foreign bodies. (4) An exploration operation was not performed during the emergency operation and subsequent operation for draining of pyogenic infection. (5) Only part of the wood or plastic fragments were removed during the operation. (6) Foreign bodies could not be extracted or were pushed deeply due to unfamiliar with the structure of the orbit, lack of adequate surgical skills or absence of necessary instruments. (7) A second CT examination was not performed and foreign body was not re-localized before the second surgery. (8) An inappropriate anesthesia method were selected (such as using local anesthesia instead of general anesthesia) so that the patient could not stand the painful operation. Many problems presented in the diagnosis and treatment of orbital foreign body, including the handling of the structure of the orbit, correct reading of CT imaging and diagnosis of orbital foreign body, well-informed operative approach, increasing the removal of orbital foreign body and decreasing the complications, these should be focused by ophthalmic surgeons.