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CASE REPORT
Year : 1993  |  Volume : 41  |  Issue : 2  |  Page : 86-87

Retained foreign body in orbit with intra cranial extension


OEU Institute of Ophthalmology, Kasturba Hospital, Manipal, India

Correspondence Address:
Ram Mohan Rao
OEU Institute of Ophthalmology, Kasturba Hospital, Manipal
India
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Source of Support: None, Conflict of Interest: None


PMID: 8262611

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How to cite this article:
Rao RM, Sekhar N C, Daniel SM. Retained foreign body in orbit with intra cranial extension. Indian J Ophthalmol 1993;41:86-7

How to cite this URL:
Rao RM, Sekhar N C, Daniel SM. Retained foreign body in orbit with intra cranial extension. Indian J Ophthalmol [serial online] 1993 [cited 2020 Nov 24];41:86-7. Available from: https://www.ijo.in/text.asp?1993/41/2/86/25614

Recent literature includes reports of cases of perfo­rating injuries with retained foreign body. The case reported here is that of a patient with a retained wooden foreign body that also entered the intracranial cavity.


  Case report Top


A 44 year old male patient attended the out patient department, complaining of protrusion of the left eve and loss of vision a few days after sustaining an injury over the left upper lid with a wooden stick. This was accompained by fever, chills and rigors. He lost con­sciousness 1 /2 to 1 hour after the fall for a period of 30 minutes. The wooden piece was removed by a local doctor 3 to 4 hours after the injury. He developed pain, redness and defective vision 2 to 3 hours after the injury. There was protrusion of left eve with total loss of vision the next day. There was no history of seizures, bleeding from the nose, mouth or vomiting.

On examination, the left eve showed axial irreduc­ible, nonpulsatile, nontender proptosis of 22 mm as measured by Hertel's exophthalmometer [Figure - 1]. Or­bital margins were normal. Extra ocular movements were absent. A 3 X 2 cm infected wound, discharging pus was noted over the upper lid. The lids were edema­tous and the conjunctiva chemosed and congested. Exposure keratitis was observed in the lower 1/4 of the cornea. The pupils were round, central and 3mm in size. Direct and consensual reflexes were absent. There was ptosis of the left eyelid.

Fundus examination showed a pale disc with blurred margins, marked pale edema of the retina giving a picture of total arterial occlusion.

There was no perception of light in the eye. The right eve was normal except for absent consensual reflex.


  Investigations Top


Radiograms of the orbit, skull and sinuses did not reveal any retained foreign body. ENT examination was normal. Neurological examination indicated a left fifth cranial nerve lesion, in addition to total ophthalmople­gia of the left eye.


  Management Top


The patient was diagnosed to have orbital cellulitis in the left eve and conservative treatment was instituted with antibiotics. There was remission and exacerbation of the infection with persistence of the discharge, all of which pointed to a retained foreign body. A search was made for the orbital foreign body by probing gently and opening the track of pus discharge. Subsequently, with a strong suspicion of orbital foreign body a CT scan was done. The scan showed a foreign body 7X 0.6 cm in the apex of the left orbit extend­ing posteriorly through the optic foramen into the middle cranial fossa (temporal lobe) of the same side [Figure - 2]. Inflammatory changes were seen in the orbit. Sphenoidal sinuses were opaque. The right orbit revealed no ab­normalities. The patient was referred to neurosurgeons for further management. A wooden stick measuring 8 X 0.75 cm was removed through a left fronto-temporal cra­niotomy. The patient was discharged one month later in a haemodynamically stable and well oriented condition.


  Discussion Top


The preceding case presents the clinical course of a man who sustained injury with a wooden object. While retained foreign bodies are not in themselves unusual, the path which the foreign body took makes an interesting variation. After having pierced the upper lid, it passed through the orbital apex to enter the intra cranial cavity, narrowly missing the carotid artery and the cavernous sinus, to finally get embedded in the temporal lobe.

This case highlights the following features :

The importance of a CT scan in patients with a history of injury with radiolucent objects, sustained dis­charge inspite of intensive antibiotic treatment and no evidence of the object even after careful probing.

The absence of cavernous sinus thrombosis and injury to carotid artery despite a medial course by the object.


    Figures

  [Figure - 1], [Figure - 2]



 

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