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| LETTER TO THE EDITOR |
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| Year : 2008 | Volume
: 56
| Issue : 4 | Page : 345-346 |
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Fatal orbitocranial injury by fencing and spectacle sidebar
Vinay V Shahpurkar, Amit Agrawal
Department of Surgery, Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), Wardha, Maharashtra, India
| Date of Web Publication | 19-Jun-2008 |
Correspondence Address:
Amit Agrawal
Division of Neurosurgery, Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), Wardha - 442 004, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0301-4738.41431
How to cite this article:
Shahpurkar VV, Agrawal A. Fatal orbitocranial injury by fencing and spectacle sidebar. Indian J Ophthalmol 2008;56:345-6 |
Dear Editor,
Transorbital orbitocranial penetrating injuries (TOPI) are relatively rare and can be caused by a variety of unusual objects. [1] A 40-year-old gentleman had fallen down from a moving lorry on a roadside fencing. The fencing bar along with his spectacle bar penetrated his right orbit. He presented approximately two hours after the accident in a drowsy condition. General and systemic examination was unremarkable. On local examination the cut end of the fencing and spectacle sidebar was entering into the skull and globe through the upper part of the right eyelid and there was profuse and active bleeding from the wound. X-ray skull showed both the metallic objects penetrating through the orbit into the cranial cavity [Figure 1]. Computed tomography (CT) scan facility and facility to perform direct puncture carotid angiogram at that time was not available. However, in view of profuse and active bleeding it was decided to remove both the objects urgently [Figure 2]. The patient underwent left frontal craniotomy by a neurosurgical team and the dural defect was repaired with pericranial graft. Following surgery the patient continued to deteriorate and expired. According to studies intracranial extension of the foreign bodies is associated with a 25% mortality rate. [2] ,[3] The intracranial lesions in these patients include ventricular damage, carotico-cavernous fistula, pneumocephalus and subdural, subarachnoid, intraventricular, and intracerebral hemorrhage. [4] Although radio-opaque foreign bodies causing such injuries may be easily located by routine X-rays, [5] it may not provide adequate details to assess the extent of intracranial damage. In patients with orbital injuries for the assessment of serious underlying intracranial injuries the recommended investigations include CT and magnetic resonance imaging (MRI). [4] ,[6] To rule out vascular injuries angiography and/or CT angiography may be needed. [6] However, in the presence of metallic objects MRI may not be possible and these objects can produce severe artifacts. At times the sophisticated facilities may not be available and if the patient's condition is such that he cannot be referred to a higher center it becomes really difficult to assess the underlying damage. In such circumstances the patients can be managed based on the available evidence but the results may not be rewarding.
| References | |  |
| 1. | Agrawal A, Pratap A, Agrawal CS, Kumar A, Rupakheti S. Transorbital orbitocranial penetrating injury due to bicycle brake handles in a child. Pediatr Neurosurg 2007;43:498-500.  [ PUBMED] [ FULLTEXT] |
| 2. | Greaney MJ. Bamboo orbital foreign body mimicking air on computed tomography. Eye 1994;8:713-4. [ PUBMED] |
| 3. | Mutlukan E, Fleck BW, Cullen JF, Whittle IR. Case of penetrating orbitocranial injury caused by wood. Br J Ophthalmol 1991; 75:374-6. [ PUBMED] [ FULLTEXT] |
| 4. | Cackett P, Stebbing J. Transorbital brain injuries. Emerg Med J 2005;22:299. [ PUBMED] [ FULLTEXT] |
| 5. | Datta H, Sarkar K, Chatterjee PR, Kundu A. An unusual case of a retained metallic arrowhead in the orbit and sphenoidal sinus. Indian J Ophthalmol 2001;49:197-8. [ PUBMED]  |
| 6. | Tenenholz T, Baxter AB, McKhann GM. Orbital assault with a pencil: Evaluating vascular injury. AJR Am J Roentgenol 1999;173:144. [ PUBMED] [ FULLTEXT] |
[Figure 1], [Figure 2]
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