Orbital Foreign Body Research Articles

Orbital Foreign Body and Ruptured Globe From Needlefish Impalement

Orbital Foreign Body and Ruptured Globe From Needlefish Impalement

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.

Orbital Foreign Bodies—Management and Therapy

Orbital Foreign Bodies—Management and Therapy

Self-Inserted Intraorbital Foreign Bodies

We report an unusual case of self-mutilation by insertion of multiple foreign bodies in the orbit. A 26-year-old female psychiatric patient with a severe emotionally unstable personality disorder was reviewed in the ophthalmology clinic. She had allegedly inserted a metal staple into her right eye 2 days previously and was complaining of pain around the right eye. Radiography showed multiple foreign bodies in the right orbit and one in the left orbit. Self-mutilation in psychiatric patients has been well documented. The management of nonorganic, nontoxic intraorbital foreign bodies is discussed. A low threshold for imaging in these cases is of vital importance.

Orbitafremdkörper - Diagnostik und Differenzialtherapie

Orbital foreign bodies constitute an interdisciplinary challenge, diagnosis being especially difficult because of inconspicuous entrance orifices. Indication for the removal of an orbital foreign body has always to be decided upon individually taking into account the benefits and risks resulting from an operation. The latter is particularly indicated if there are acute and chronic functional restrictions or inflammatory reactions either present or to be expected. The objective of our study was to produce systematic guidelines concerning the therapeutic procedure of dealing with orbital foreign bodies with a view to a benefit-risk assessment. Over the last ten years ten patients with an orbital foreign body were treated in our Department, four of them requiring acute attention. CTs were taken of all patients. Only in one case additional MRTs were produced. Eight out of ten patients underwent operation, of which seven resulted in a complete removal of the foreign body. In the case of two patients we decided against an operation after interdisciplinary consultation. In our view the imaging--providing diagnostics by means of computer tomography is the most promising method for determining a foreign body in the orbit. Decision for an operative removal of a foreign body was invariably taken interdisciplinary in cooperation with an ophthalmologist. Surgical approach was chosen in accordance with the localisation of the foreign bodies. None of the patients suffered from a loss of vision or a restriction of functions as a result of the operation. In the indication the foreign material is of essential importance. Orbital foreign bodies that have been present in the tissue for a longer time can be allowed to stay, unless loss of functions are progressive. Loss of vision always being a consequence of the initial trauma.

Temporary Balloon Occlusion of the Cavernous Carotid Artery for Removal of an Orbital and Intracranial Foreign Body: Case Report

We describe the first reported use of temporary balloon occlusion of the cavernous internal carotid artery for controlled removal of a foreign object from the cavernous sinus. This endovascular approach may be an alternative to craniotomy in highly selected cases. A 34-year-old incarcerated male attempted suicide by stabbing the earpiece of his glasses through his right orbit into the intracranial compartment. He presented with complete ophthalmoplegia. The earpiece traversed the cavernous sinus, penetrating its posterior wall to enter the perimesencephalic cistern and cerebellum. Angiography demonstrated a small direct carotid-cavernous fistula. Removal of the foreign body was performed under general anesthesia in the angiography suite with the operating room on standby. Nondetachable and detachable balloons were inflated in the cavernous carotid artery to provide vascular control while the foreign body was withdrawn from the cranium at the orbit. Follow-up angiographic runs with the balloons deflated revealed minimal arteriovenous shunting, which disappeared on subsequent studies. The balloons were removed. The patient remained neurologically stable with his baseline right ophthalmoplegia and V1-V2 hemianesthesia. At the 6-week follow-up, the patient remained clinically stable with no evidence of carotid-cavernous fistula or interval abscess formation. Endovascular temporary balloon occlusion of the cavernous carotid artery provides immediate control of the vessel (with an option of permanent carotid sacrifice), allowing removal of a foreign body without craniotomy in appropriate cases.

Extraction of lead pellet foreign body in orbit

目的 探讨眼眶异物气枪铅弹的摘出方法及难点.方法16例(16眼)眼眶气枪铅弹异物在X线摄片或CT扫描后,在X线透视直视下以血管钳夹住有软组织包裹的异物铅弹,再用另一血管钳同路伸入对异物铅弹外包之软组织进行分离,直接夹出铅弹.结果16例眶内异物铅弹均成功取出.结论在X线摄片或CT扫描后,在X线透视直视下,以两把钳分别夹持及分离可以较易摘出眶内气枪铅弹。

Retained Intraorbital Metallic Foreign Bodies

To document the biological tolerance of retained metallic orbital foreign bodies managed with conservative treatment. A retrospective chart review of 43 patients treated between 1987 and 1993 with retained intraorbital metallic foreign bodies was performed. Age, sex, injury, imaging studies obtained, location of the foreign body, initial and final visual acuity, length of follow-up, treatment, and related adverse reactions and/or complications were recorded. Fifty cases involving 34 male and 9 female patients ranging in age from 2 through 63 years (median, 25 years) were included. Seventeen cases were the result of gunshot wounds, 17 were from BB gun injuries, and 16 cases were from shotgun injuries. Forty-two patients had CT scans to assess the injury and one patient had plain radiographs. In 37 cases, the metallic foreign bodies were located posterior to the globe. There were 19 ocular penetrating injuries, 11 ocular contusion injuries (sclopetaria, commotio retinae, vitreous hemorrhages), and 20 injuries with no ocular involvement. Initial visual acuity ranged from 20/20 to no light perception, as did final visual acuity. The metallic foreign bodies were retained from 6 months to 68 years (median, 2 years). There were 19 ocular penetrating injuries, including 12 enucleations and 7 primary repairs. When contusion injuries were sustained, treatment consisted of vitrectomy for the removal of persistent hemorrhages (3 cases), exploration of the globe (1 case), and nonsurgical treatment (7 cases). Among the 20 cases with no ocular involvement, only 2 patients had secondary complications that required surgical intervention: One had mechanical strabismus, the other a sterile abscess. Visual acuity remained stable or improved in all cases. There were no late complications from the retained foreign bodies in 36 (95%) of 38 cases when the eye remained intact. Retained intraorbital metallic foreign bodies are well-tolerated and typically have minimal adverse visual prognosis. They should be managed conservatively in the absence of specific indications for removal.

Retained orbital wooden foreign body: a surgical technique and rationale

Objective To emphasize the potential complications of a retained orbital wooden foreign body (WFB) and the rationale of a surgical technique. Design Two interventional case reports. Participants Two patients sustained an orbital WFB injury. Both patients had ocular complications despite repeated attempts to remove the suspected residues. Intervention Computed tomography and magnetic resonance imaging of both patients at different intervals revealed evidence of orbital foreign body migration toward the cranium. A surgical technique combing transcranial and orbital approaches was used to remove the residues. Main outcome measures Preoperative and postoperative vision, proptosis, ocular motility, and various ocular symptoms and signs. Results In both patients, no postoperative complications were seen, and all preoperative symptoms and signs were resolved at 9- and 19-month follow-ups, respectively. Conclusions A retained orbital WFB can cause early or late complications and is known to have the potential to migrate intracranially. In selected patients, a team approach may be the best technique to ensure complete removal.

Corpo estranho orgânico intra-orbitário: avaliação tomográfica e conduta

Introdução: A apresentação clínica do corpo estranho intra-orbitário (CEIO) é variada. A conduta e o prognóstico vão depender da composição do corpo estranho, localização e presença ou não de infecção. Objetos metálicos e de vidro são os mais freqüentes e bem tolerados, ao passo que os orgânicos causam maior reação inflamatória, podendo levar a sérias complicações. É freqüentemente difícil identificar e localizar o corpo estranho intra-orbitário apesar dos modernos métodos de exames de imagem. Objetivo: Avaliar a contribuição dos exames de imagem no diagnóstico bem como a conduta adotada em pacientes com corpo estranho intra-orbitário orgânico. Métodos: Foram avaliados 3 pacientes com corpo estranho intra-orbitário de natureza orgânica após trauma penetrante. Resultados: Todos os pacientes foram submetidos à remoção do corpo estranho, apresentando melhora do quadro clínico. A tomografia computadorizada (TC) foi essencial na avaliação, identificação e localização do corpo estranho. Conclusão: A identificação pré-operatória, com auxílio da tomografia computadorizada, do corpo estranho intra-orbitário foi útil para a condução do caso. A remoção do corpo estranho de natureza orgânica deve ser feita com o objetivo de minimizar possíveis complicações.

Transnasale Chirurgie der Orbita

The endonasal surgery has a branch in the transnasal orbital surgery. For this transnasal approach the anterior skull base, the medial and infero-medial orbita, the orbital apex with the optical nerve and the sphenoid sinus are within reach. In all primary and secondary malignant lesions with extension into the orbita, the transnasal biopsy is of importance for diagnosis, particularly in metastasis to the orbit and pseudo-tumors. Benign lesions like mucoceles and osteomas are accessible and fully removable. Good results have been obtained in endonasal orbital decompression and inhomogeneous space occupying intraorbital lesions like bleedings. Among the orbital traumatism, with restrictions fractures of the medial orbital wall, medial orbital floor and foreign bodies could be operated. The transnasal approach is not indicated in all diseases, which are situated mostly intraconally, supraorbitally and lateral of the bulbus as well as in tumors with intracranial extension. In summary, the transnasal orbital approach has its place as helpful addition to the transfacial and transcranial techniques and can even replace them in certain selected indications.

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.

Radiographic Screening for Orbital Foreign Body Prior to MRI is Neither Cost Effective Nor Clinically Necessary as Recently Recommended

To evaluate the cost effectiveness of clinical versus radiological screening for orbital foreign body prior to MRI. Costs of screening were developed using data available in medical literature, disability rating guides and practice survey. Base case estimates were derived based on published guidelines. A single state change model was constructed, social cost was the unit of analysis. Sensitivity analysis was performed over plausible ranges for each variable. Using base case estimates and a discount rate of zero, the cost of the current guideline is $328,580 per quality adjusted life year saved. The analysis identifies screening cost as a critical variable. Discount rates and effectiveness of foreign body removal also are important variables. Probability of injury and prevalence of foreign body may impact the analysis. Clinical screening prior to radiography would be expected to reduce the cost of screening by an order of magnitude, assuming base case ocular foreign body removal rates. Clinical screening prior to radiological screening would increase the cost effectiveness of foreign body screening by an order of magnitude. Simply asking the patient “Did a doctor get it all out?” accomplishes this goal Occupational history by itself is not sufficient to mandate radiological orbital screening. Current practice guidelines for foreign body screening should be altered.

Imaging of the normal and pathological orbit.

Computerized techniques (CT and MRI) allow precise delineation of orbital anatomy and abnormalities. Orbital tumors are nicely depicted by these methods; various examples are illustrated in this article, with discussion of the respective impact of CT and MRI. Orbital inflammation and foreign bodies usually represent radiologic emergencies, prompting use of CT (frequently) or MRI (occasionally). Digital subtraction angiography (DSA) is indicated for diagnosis of vascular changes (mainly carotid-cavernous fistula, aneurysms, angiomas, Rendu-Osler disease). Angiography is usually done to ascertain the possibility of an interventional procedure. Orbital vascular interventions include re-canalization of occluded vessels, and embolization of pathologic (tumorous or post-traumatic) vessels.

Neuro-ophthalmologic complications of sinus surgery

Purpose: To describe the neuro-ophthalmologic complications of sinus surgery. Methods: The charts of seven patients who suffered visual loss and/or diplopia following sinus surgery were retrospectively reviewed. Results: Clinical findings included orbital hematoma, orbital foreign body, extra-ocular muscle dysfunction, optic neuropathy, and a chiasmal hematoma. Conclusions: Sinus surgery may result in significant neuro-ophthalmologic complications.

Diagnosis and management of orbital inflammation and infections secondary to foreign bodies: a clinical review

Orbital inflammation and secondary infections may be caused by many types of foreign bodies, including organic and inorganic matter, non-autogenous surgical implants and allografts, and surgical hardware and materials utilized in reconstructive surgery. In penetrating injury patients, the nature of the foreign body determines the clinical behavior; inert objects such as steel and glass may not cause significant inflammation to warrant their removal. Removal of organic foreign bodies, however, is mandatory since these objects usually lead to secondary infection with abscess and fistula formation. This paper reviews salient points related to history-taking and physical examination, diagnostic workup, and medical and surgical treatment in foreign body-induced orbital inflammation and infections. It is emphasized that practically every case of orbital trauma should be approached with a high index of suspicion for penetrating injury with possible intraorbital foreign body. The investigational tools to detect orbital foreign bodies, including ultrasonography, computed tomography and magnetic resonance imaging, are reviewed. The principles of the management, including antimicrobial therapy, surgical indications and techniques, are also discussed.

Orbital Avitene Granuloma Formation After Enucleation for Intraocular Retinoblastoma

To report a case of orbital foreign body granuloma formation, mimicking tumor recurrence, secondary to the use of Avitene after enucleation for intraocular retinoblastoma. Eight months after undergoing enucleation for retinoblastoma, a 21-month-old boy underwent a biopsy of an orbital mass. Histopathologic examination of the orbital biopsy specimen disclosed a proliferative granulomatous foreign body reaction surrounding multiple foci of a coarse fibrillar intercellular substance consistent with Avitene. No retinoblastoma cells were present. A foreign body reaction should be included in the differential diagnosis of orbital mass lesions after surgery in which Avitene is used.

A Simple Aid for Localizing Magnetic Foreign Bodies in the Anterior Orbit.

A Simple Aid for Localizing Magnetic Foreign Bodies in the Anterior Orbit.

Magnetic resonance imaging and the dangers of orbital foreign bodies

Magnetic resonance imaging and the dangers of orbital foreign bodies

開頭手術により著明な眼球突出が改善した多量の眼か内異物症例

A 20-year-old man presented with severe exophthalmos on the left as a result of a traffic accident. X-ray films revealed that foreign bodies, suspected of being parts of the windshield, had extended into the orbital apex. An intracranial lesion, however, could not be excluded. Craniotomy (fronto-zygomatic approach) was performed to remove the orbital foreign bodies, while preserving the optic nerve, and to identify intracranial foreign bodies in a wide surgical field. No dural lacerations or intracranial foreign bodies were observed during surgery. Total removal of the orbital foreign bodies was accomplished via the left fronto-zygomatic approach. Postoperatively, there was marked improvement in the severe exophthalmos, and visual acuity was restored. This type of surgical procedure is a good approach for removing deep orbital foreign bodies and checking for the presence of possible intracranial foreign bodies.