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   Table of Contents      
CASE REPORT
Year : 1993  |  Volume : 41  |  Issue : 3  |  Page : 129-130

Orbital injuries in children : Play-related


Department of Ophthalmology, School of Medical Sciences, Malaysia

Correspondence Address:
S R Shriwas
Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia

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Source of Support: None, Conflict of Interest: None


PMID: 8125546

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How to cite this article:
Shriwas S R, Kinzha AZ. Orbital injuries in children : Play-related. Indian J Ophthalmol 1993;41:129-30

How to cite this URL:
Shriwas S R, Kinzha AZ. Orbital injuries in children : Play-related. Indian J Ophthalmol [serial online] 1993 [cited 2020 Sep 19];41:129-30. Available from: http://www.ijo.in/text.asp?1993/41/3/129/25604

The incidence of orbital and periorbital injuries account for 22% of all ocular trauma. [1] These are being recognised more frequently perhaps because of the advances in diagnostic modalities such as CT scan. [2] Child play-related orbital injuries may result in structural and functional damage to the eye or surrounding parts.


  Case report Top


An 8-year-old boy was accidentally pierced in the right eye with a wooden stick by his friend. In an attempt to remove it, the stick broke leaving a fragment partially embedded in the right orbit. Examination of the right eye revealed a visual acuity of 6/18 and a protruding wooden piece from the mid-point of orbital portion of upperlid which was immovable in all directions [Figure - 1]. The upper lid was partially covering the cornea and the globe was intact, but elevation was restricted. Computed tomography of the orbits showed a radiolucent object, 8 mm in cross-section in the right orbit. The entry point was 2 mm under the right superior orbital margin. The wooden stick had pierced through the soft tissue of the orbit, grazing the outer side wall of the eyeball [Figure - 2]. While it angulated posteriorly piercing through the rim, the tip had penetrated the orbital roof and was seen resting on top of the posterior wall of the orbit. Two bone fragments were lodged in the right frontal lobe near the orbit [Figure - 3].

A 2.5 cm long foreign body was removed under general anaesthesia. Initial attempts to remove it by using a toothed forceps were unsuccessful; Kochers forceps was successfully used as an alternative. Orbital exploration did not reveal any remnant of wood. The lid laceration was closed with 6/0 chromic catgut. A two-month postoperative follow-up revealed a visual acuity of 6/6, normal upper lid position, and full ocular movement of the right eye.


  Discussion Top


Child play with a stick may cause damage to the orbital contents (nerve, muscle, and blood vessel) cranium, dura, or the brain. As it may result in serious visual disability, a thorough examination and prompt management is mandatory. [2],[3] It is possible that restricted globe and lid movement in our patient may be due to firm placement of the wooden block between fractured orbital roof and lacerated lid. This indicates that the piercing force was severe enough to cause these damages.

Orbital roof fracture is common in childhood and both downward and upward displacement of bone fragments have been reported previously. [4] In our patient, two minute bone fragments were found lying in the right frontal lobe due to severe impact to the orbital roof by the wooden stick. However,there was no acute neurological deficit.

From our experience, we suggest that an immov­able orbital foreign body should be evaluated for possible roof fracture and brain damage. The CT scan is a very valuable diagnostic tool in such circumstances and prompt management can improve the outlook for many cases.

 
  References Top

1.
Ellen S, Michael E, Erich D, and Susan B. Causes of pediatric eye injuries. Arch Ophthalmol 108: 603, 1990.  Back to cited text no. 1
    
2.
Elizabeth ME, and Roper-Hall MJ. Orbital Injuries; Eye Injuries. London, Butterworth: 3.1, 1986.  Back to cited text no. 2
    
3.
John CM. The orbital walls, Repair and reconstruction in the orbital region. Edinburgh, Churchill Livingstone: 245,1980.  Back to cited text no. 3
    
4.
Greenwald MJ, Boston D, Pensler JM, and Radkowski MA, Orbital roof fractures in childhood. Ophthalmology 96: 491-97, 1989.  Back to cited text no. 4
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3]


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