Penetrating Orbital Injury Research Articles

Orbitoethmoidal foreign body through traumatic penetrating orbital injury

Foreign bodies in the nasal cavity, paranasal sinuses, and orbit are commonly related to high-velocity maxillofacial injuries. Cases of foreign bodies in paranasal sinuses are very rare. They may present with non-specific symptoms which make them easily neglected during history taking and clinical assessment. High clinical suspicion and radiological assessments are essential in patients with high-velocity insult to rule out the possibility of impalement injury. The course of management is determined by the location and type of foreign body. We share a rare case of metallic foreign bodies in the orbitoethmoidal region which took a combined surgical and conservative course of treatment involving a multidisciplinary team.

Chronické cizí těleso v očnici

A foreign body in the orbit is a relatively uncommon but serious complication of a penetrating orbital injury. The clinical manifestations of a chronic foreign body may be insignifi cant. Also, dia gnostics and accurate localization of foreign bodies in orbit (especially organic) using imaging methods may not always be unambiguous. In the case report, we describe the case of a two-year-old boy with a woody foreign body in the orbit, whose dia gnosis was delayed, despite repeated surgical interventions and imaging, and the foreign body was removed more than six months later laterally. Keywords: foreign body in orbit – orbita injury in children – medial orbitotomy

Presentation and Management of a Complex Orbital Apex Syndrome From Penetrating Mechanical Spring Hook: A Case Report

Our case report demonstrates the management of a unique penetrating orbital injury. The intraorbital foreign body was an approximately 22 cm long metal dishwasher spring hook lodged into the left orbital apex. An ophthalmological check-up a couple of weeks following the removal surgery discerned the patient had anunprecedented case of orbital apex syndrome. We present this unique case so physicians, medical students, and other emergency and medical professionals can learn about the diagnostic, surgical, and multidisciplinary management necessary to achieve a favorable clinical outcome.

Orbital Penetrating Injury by Bamboo-Stick, Mimicking Air in Computed Tomography: A Case Study

Orbital penetration injuries by an organic foreign body are relatively rare. It is difficult to detect by computed tomography (CT) scan. Penetrating injuries through the skin, can cause serious orbital complications. This report presents the first case of an intra-orbital penetrating injury caused by a bamboo.

Removal of an Impaled Intraocular Hair Comb Following Self-inflicted Trauma

Ocular trauma is one of the most common and vision-threatening ophthalmic presentations with a wide spectrum of complications, such as bleeding, infection, vision loss, and enucleation. A 64-year-old-male presented to the emergency department (ED) with a self-inflicted orbital penetrating injury with a hair comb. Computed tomography showed the comb traversed the medial orbit inferior to the medial rectus but did not damage the optic nerve; there were no globe or orbital wall fractures. His ocular exam was significant for a right eye afferent pupillary defect and decreased visual acuity 20/800, consistent with optic neuropathy. Primary concerns were stabilizing and removing the foreign body without causing further damage in the setting of an uncooperative patient. The comb was removed with the aid of local and systemic analgesia using gentle traction and normal saline irrigation. The patient was admitted for systemic and topical antibiotics and showed improvement in visual acuity and resolution of his optic neuropathy. This case illustrates the importance of rapid ED assessment and management of complex penetrating ocular trauma. Examination should specifically look for signs of globe rupture and optic nerve injury. Expedited foreign body removal should be managed together with an ophthalmologist with procedural sedation and broad-spectrum antibiotics to avoid further visual and infectious complications.

An unusual case of globe-sparing penetrating orbital injury by a nail

We describe a case of a 28-month-old boy who presented to our emergency department with a right orbital penetration by an iron nail. At presentation, no pain or functional loss were noted. Plain head radiographs and computed tomography were performed and demonstrated a two centimeters long nail penetrating the right orbit. The foreign body was extracted carefully in the operating room. No complications were observed upon follow-up. Rarely, orbital penetration by an iron-nail can present without functional disturbances or pain and is not necessarily accompanied by sequelae.

Civilian Occult Orbitocranial Penetrating Injury Presenting with Cerebral Abscess in Elderly Patient

AbstractOrbital penetrating injuries are uncommon and occur following accidental entry of objects through orbit. The authors report an interesting case of right frontal abscess resulting from orbitocranial penetrating injury due to accidental penetration of wooden stick into the right eye, which remained undiagnosed. A 70-year-man presented with complaints of headache and vomiting for few days. His computed tomographic (CT) scan of the brain revealed peripheral rim-enhancing cystic lesion in the right frontal lobe with perilesional edema, mass effect, and midline shift. Orbital CT scan revealed hyperdense lesion just lateral to medial orbital wall. Magnetic resonance imaging of the brain showed cystic peripheral rim-enhancing lesion that was homogenous hypointense on T1-weighted images and homogenous hyperintense on T2-weighted images. The patient underwent right frontal craniotomy. Pus was drained out, and abscess wall was excised. Foreign bodies protruding through fractured orbital roof were found and removed. He made good clinical recovery. He has received intravenous antibiotics for 2 weeks followed by 4 weeks of oral antibiotics. He had no visual symptoms. The authors report the case, review the literature, and highlight need for imaging in every case of orbital penetrating injury to prevent the life-threatening cerebral parenchymal complications.

Brief account on the head injury of a noble youngster in the sixteenth century (Prince Don Carlos, heir to Philip II of Spain, 1545-1568).

Some traumatic events, among them head injuries, are occasionally reported in the medical literature to illustrate relevant affairs that sometimes modify the course of the history [7, 8, 14]. Some of these incidents involve persons of royal lineage, as happened with King Henry II of France who suffered a penetrating orbital injury complicated by a brain contusion and an intracranial empyema that caused the King’s death [7, 14]. In addition to the historical interest that these traumatisms arise, they undoubtedly provide an occasion to review the level of the medical practice in a determined epoch. For this purpose, we retrospectively surveyed the events regarding the unfortunate life of Prince Don Carlos, first-born son and heir to King Philip II of Spain, whose infancy and adolescence were plagued with a multitude of medical troubles including inherited traits, recurrent bouts of malaria, and finally, the deadly complications of a seemingly trivial head injury [4, 8, 11, 12]. The descriptions regarding Don Carlos’ skull trauma have been documented from the official medical reports of doctors Olivares and Daza Chacon and from the brief English account of the accident written by Thomas Chaloner, ambassador of her majesty the Queen Elizabeth of England [4, 8, 11]. Don Carlos’ case report

CT Angiography Evaluation of Unusual Transorbital Penetrating Injury: A Toothbrush

Orbital penetrating injuries may cause significant harm to optic nerves and eyeball as well as to the brain and cerebral vasculature. Defining surrounding neurovascular structures by CT angiography (CTA) is important for surgical removal. We present an uncommon case of a 3-year-old child with a penetrating orbital injury caused by a toothbrush. To the best of our knowledge, there is no report orbital injury with a toothbrush so far.

Transorbital orbitocranial penetrating injury caused by a metal bar

Transorbital intracranial injury is uncommon, representing 0.04% of penetrating head trauma with a high mortality rate. Orbital penetrating injuries may cause severe brain injury if the cranium is entered, typically via the orbital roof, the superior orbital fissure, or the optic canal. A 13-year-old male sustained a severe brain injury due to penetration of the right orbit with an iron bar. The bar entered the inferiomedial aspect of the orbit and emerged from the left occipital bone. Neurological examination revealed deep coma (GCS: E1M2V1) with fixed, dilated, and non-reactive pupils. The bar followed an intracranial trajectory, through the third ventricle and suprasellar cistern. The patient underwent an immediate exploration with removal of the bar. Unfortunately, he died 10 days postoperatively due to severe diencephalic injury with brainstem herniation. In this case report, we discuss the radiologic diagnosis and surgical management of transorbital orbitocranial injury by foreign body penetration.

Orbitocerebral injury by a knife: case report

Orbital penetrating injuries may cause significant harm to the optic nerves and eyeball as well as to the brain and cerebral vessels. Management of orbital foreign bodies should include prompt recognition of the extent of the injury, broad-spectrum parenteral antibiotics, tetanus prophylaxis, anticonvulsant medication and early surgical intervention under direct vision to remove the foreign body and to avoid immediate and long-term complications. We report a penetrating orbital injury caused by a bread knife that extended from the orbit to the tegmental dura mater of the temporal bone. The knife's main trajectory coursed through the temporal lobe. Adjacent cerebral structures were explored before removal of the knife.

Nonsurgical Management of an Intraorbital Pencil Without Cranial or Globe Penetration

A 3-year-old boy suffered a penetrating orbital pencil injury in the right upper eyelid. Examination showed no signs of globe perforation, fractures, or neurologic deficits. The pencil was removed with controlled and slow motion. Visual acuity was 20/20 and anterior and posterior segment findings were normal 2 months after the injury.

Intracranial Penetrating Orbital Injury

The authors report a case of double-penetrating injury of the globe with intracranial involvement from a pellet gun. A 16-year-old boy had a visual acuity of bare light perception in the left eye after being hit by a pellet. There was an inferior limbal entry site, dense hyphema, and no view of the fundus. Computed tomographic scan showed the pellet intracranially close to the left cavernous sinus. After neurosurgical clearance, the patient underwent primary closure of the corneoscleral entry site followed 3 weeks later by pars plana vitrectomy, lensectomy, and repair of a rhegmatogenous retinal detachment. At 12 months postoperatively, visual acuity was 20/300 and the retina was attached. Our case demonstrates the potential for significant visual recovery in some patients with a penetrating orbital injury and intracranial involvement. Complete radiographic evaluation with neurosurgical consultation is important in the management of these patients prior to ophthalmologic intervention with possible foreign body removal. There is a need for more public awareness regarding the potentially harmful effects of pellet guns.

Management of Combined Penetrating Intraorbital and Intracranial Trauma

Penetrating orbitocranial trauma is fortunately an uncommon type of injury. 1,2 Intracranial extension of a foreign body can damage vascular and neural structures. Close cooperation between ophthalmologists and neurosurgeons is essential to maximize visual potential and minimize the risk of devastating neurologic complications. We report an unusual case of penetrating orbital injury with a foreign body extending deeply into the cranium. Report of a Case. —An 11-year-old boy presented with a penetrating orbital injury. While playing with a sled, a cord fabricated to pull it consisting of a length of rubber tubing ensheathing a shorter segment of steel rod gave way after a vigorous tug and was thrust into the right orbit. On examination a 5-cm portion of metal rod covered with rubber tubing was protruding from the area of the right medial canthus (Fig 1). Visual acuity was 20/200 OD with an 8-mm pupil with minimal light reactivity; however,