Delhi Journal of Ophthalmology

An Unusual Intraorbital Foreign Body

Ajay Kumar Singh
Medical Officer
Venu Eye Institute & Research Centre
New Delhi, India

Corresponding Author:

Ajay Kumar Singh
Medical Officer
Venu Eye Institute & Research Centre
New Delhi, India
Email: dr.ajay2911@gmail.com


Received: 12-JUL-2016

Accepted: 15-OCT-2016

Published Online: 26-DEC-2016

DOI:http://dx.doi.org/10.7869/djo.247

Abstract

Keywords :

The most common modes of head and neck trauma include road traffic and occupational accidents.[1] Injury with household equipments is also not uncommon. Complete removal of foreign body with maximum preservation of eyeball, extraocular muscles, and the optic nerve functions is the ultimate goal.[2] Delayed surgical intervention is known to be associated with poorer prognosis.[3]
A 26-years-old lady presented to the emergency ward with history of trauma to her right eye with the pressure regulator of the pressure cooker while working in kitchen two hours back. She was conscious and her vitals were within normal limits. There was no perception of light in the right eye, it was auto-eviscerated with exposed uveal tissue and oedematous upper lid. The pressure regulator was seen embedded in the right orbit, abutting medial orbital wall. Blood clots were present in nasal and orbital area along with lacerations over right side of forehead (Figure-1). Left orbit and eye were normal with BCVA (Best Corrected Visual Acuity) of 20/20 (0.0 on logMAR scale). To check nasal bleeding, nasal packing was done at once. No active haemorrhage from orbit was noted after cleaning the blood clots (Figure-2). CT-scan was advised but patient could not afford it. X-Ray showed fracture of medial orbital wall. with penetration of the foreign body for approximately three cm (centimetres) inside the bony orbit (Figure-3).



 
Any injury to superior or inferior orbital wall and the anterior cranial fossa was ruled out. Removal of the retained foreign body under local infiltrative anaesthesia with evisceration of the uveal tissue without implant along with primary suturing of the skin lacerations was planned. The surgery was done primarily by the ophthalmic surgeon in association with an ENT (Ear, nose and throat) and a maxillofacial surgeon. The foreign body was rotated along its own axis and gently pulled as a single piece via its own track of injury, thus avoiding any injury to surrounding structures. (Figure 4)


No active haemorrhage was noted from bed of the track, probably owing to cauterization of the surrounding tissue by hot metallic foreign body. After removing debris from the bed, packing with antiseptic (povidone-iodine) and xylometazoline soaked gauze was done. Due to loss of significant amount of soft tissue, primary suturing was not done and the wound was left to heal with secondary intention. Evisceration, suturing of sclera, conjunctiva and skin lacerations was also done in the same sitting. (Figure-5,6)




Post-operative treatment included oral antibiotic and anti-inflammatory medicines. Three months later, the patient was referred to ocularist for custom-made ocular prosthesis.
Extensive injuries with foreign body impaction require an early surgical exploration and foreign body extraction.[4] A multidisciplinary approach results in reasonable functional and cosmetic outcome.[5]

References

1.    Singh V, Kaur A, Agraval S. An unusual intraorbital foreign body. Indian J Ophthalmol 2004; 52:64–5.
2.    Espaillat A, Enzer Y, Lipsky S. Intraorbital metallic foreign body. Arch Ophthalmol 1998; 116:824–5.
3.    Hefner L, Tegetmeyer H, Sterker I, Wiedemann P. Diabolo-Verletzung mit Lokalisation des Fremdkorpers im Bereich der Orbitaspitze-ein Fallbericht. klein Monatsbl Augenheilkd 2005; 222:923–7.
4.    Al-Mujaini A, Al-Senawi R, Ganesh A, Al-Zuhaibi S, Al-Dhuhli H. Intraorbital Foreign Body: Clinical Presentation, Radiological Appearance and Management. Sultan Qaboos Univ Med J 2008; 8:69–74.
5.    Markowski J, Dziubdziela W, Gierek T, Witkowska M, Mrukwa-Kominek E et al. Intraorbital foreign bodies – 5 own cases and review of literature. Otolaryngologia Polska 2012; 66:295–300.


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Ajay Kumar SinghAn Unusual Intraorbital Foreign Body.DJO 2017;27:213-214

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Ajay Kumar SinghAn Unusual Intraorbital Foreign Body.DJO [serial online] 2017[cited 2019 Oct 19];27:213-214. Available from: http://www.djo.org.in/articles/27/3/an-unusual-intraorbital-foreign-body.html