|Year : 1982 | Volume
| Issue : 1 | Page : 53-55
Orbital foreign body-case reports
G Baskararajan, M Danodarasamy, P Sivaramasubramanian, S Thiyagarajan
Madurai Medical College, Madurai, India
Asst. Surgeon in Ophthalmology, Govt. Rajaji Hospital, Madurai-20
Source of Support: None, Conflict of Interest: None
|How to cite this article:
Baskararajan G, Danodarasamy M, Sivaramasubramanian P, Thiyagarajan S. Orbital foreign body-case reports. Indian J Ophthalmol 1982;30:53-5
The orbital cavity can lodge any unexpected tumours or foreign bodies. Foreign bodies often remain within the orbit for a considerable length of time-even upto many years without causing troublesome symptoms or signs. A different situation is observed with intra orbital retention of organic foreign bodies, particularly of wood. After an initial quiescent period of considerable variability in duration ranging from days to years complications often arise. There may be granuloma, orbital cellulitis, orbital abscess, osteomyelitis, periosteitis or chronic draining fistula, through the conjunctiva or through the palpebral skin. Retained foreign body is frequently missed due to its location within the orbit and its relative radio-luscency.
Two cases of retained wooden foreign body in orbit, with unusual presentations are reported.
| Case reports
S. Male aged 13 years fell down from a tree while playing He was treated in a hospital for the injury in the left upper lid. Bits of wood and leaves were removed from the site of injury in the upper medial aspect of left upper lid. Since pus continued to ooze from the site of injury and papilloedema developed in both eyes, the patient was referred to this hospital one month after the injury. X-ray orbit revealed periosteal reaction of orbital roof near the wound site. EEG was normal. The patients' general health was good. A diagnosis of retro-orbital abscess was made.
On examination, vision RE: 6/6 LE: 6/36. Diplopia chart revealed left superior rectus palsy. There was bilateral papilloedema and a fistula discharging pus from the site of injury. [Figure - 1] The patient was afebrile. Pus was sent for culture and sensitivity. Culture for fungus also was done. The report was nonspecific pyogenic organisms sensitive to gentamicin. He was treated accordingly. Since small bits of vegetable matter were noted in the pus, exploration under general anaesthesia was planned. A few hours prior to the surgery, spontaneous extrusion of a piece of wood of 3.5 cms in length occurred. [Figure l]b. To rule out any more retained foreign body, exploration was carried out as planned and some more bits of wood were removed. Re-exploration had to be done after a week to remove few more pieces and the wound got healed up. The papilloedema subsided subsequently. The patient was discharged with slight degree of diplopia and visual acuity of 6112 in left eye.
Case No. 2
A 65 year old female A reported with a history of spitting out a piece of wood of 7cms length along with pus. She gave history of injury 2 months back due to a fall from bullock cart. Later she developed a discharging wound near the inner canthus of left eye and also discharge of foul smelling material into her throat. Examination revealed that the wound was lined by granulation tissue. [Figure - 2]a Vision was 6/1.2 in both eyes (she had immature cataract). Extra ocular movements were normal and there was no diplopia. ENT examination revealed a fistula discharging pus in the middle meatus on left side. A metal probe was passed carefully through the fistula near the canthus. The patient could feel the probe inside her nose. X-rays were taken with the probe in position to trace the fistulous tract [Figure - 2]b. The fistula was explored and few more small bits of wood were removed. The fistula was irrigated with antibiotic solution. Following the treatment with antibiotic and anti-inflammatory drugs, the wound healed up.
It is surprising to come across such lengthy foreign bodies which are retained for long periods without the patients being aware. The wooden particles in the above cases have examined in orbit for a long time with discharging fistulous tracts, a known complication. In case No.1, the diplopia could be explained as due to direct trauma to the superior rectus muscle as well as to inflammatory process affecting the muscle and nerve fibres supplying it.
The defective vision could be due to retrobulbar neuritis. The bilateral papilloedema is unusual, which might have been due to a subclinical aseptic cavernous sinus thrombophlebitis, as the patient was treated with antibiotics from the time of injury.
In case No.2, the route of entry of the foreign body from orbit into the nasal cavity has been demonstrated by X-rays with a metal probe in situ.
If a foreign body enters with sufficient force, it may enter several structures like the frontal sinus, the maxillary antrum, ethmoid and sphenoid sinuses or the nose. It may even traverse the nose and enter the opposite maxillary antrum, or the opposite orbit and form a bilateral foreign body.
Two cases of chronic retained wooden orbital foreign bodies with unusual clinical presentations are reported. In both the cases, spontaneous extrusion of foreign body occurred.
Macral J.A. 1979, Brit. J, Ophthalmol 63; 848.
[Figure - 1], [Figure - 2]