Year : 1987 | Volume
: 35 | Issue : 3 | Page : 126--128
Intra-orbital foreign bodies and their management
Ashok Kumar Sinha, Ajit Sinha
BanshiKunj, Kadamkuan, Patna 800 003, Bihar, India
Ashok Kumar Sinha
BanshiKunj, Kadamkuan, Patna 800 003, Bihar
Four cases of recurrent abscess of the ocular adnexa with retained intra orbital foreign body are reported The peculiar feature is that there was no ocular injury in spite of the large size and abnormal structure of the impacted intra orbital foreign bodies retained for a long period of time.
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Sinha AK, Sinha A. Intra-orbital foreign bodies and their management.Indian J Ophthalmol 1987;35:126-128
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Sinha AK, Sinha A. Intra-orbital foreign bodies and their management. Indian J Ophthalmol [serial online] 1987 [cited 2021 Jan 16 ];35:126-128
Available from: https://www.ijo.in/text.asp?1987/35/3/126/26200
With increased industrialisation mechanical and agricultural development injury to the eye by foreign bodies is commonly seen in clinical practice and most of them may be disastrous to the eyes.
The orbital cavity is protected anatomically by bony projections and by blinking action of the lids Ocular injuries are more common in cases of orbital foreign bodies, but there may be cases where, in spite of deep intra-orbital foreign body, there is no anatomical or physiological damage to the eye ball Even intra-orbital extra-ocular foreign bodies do produce emergencies from the ophthalmic point of view. With this in view this paper is being presented with regards to the management of intra-orbital foreign bodies.
Materials and Methods
Four cases have been studied in the AR Eye Institute, Patna All these cases went through a thorough history taking, with visual acuity assessment slit lamp examination, ophthalmoscopy and X-ray of the orbits Only intra-orbital (extra-ocular) cases have been included in this study.
Observation and Discussion
MRK 9 years presented with a complaint of recurrent swelling and discharge from the left lower lid in the region of the lacrimal sac for the last 3 months following an injury with a pencil This was followed by recurrent swelling and abscess formation which was repeatedly drained by the surgeons On examination, the visual acuity was6/6 in each eye and externally the eye ball was normal with no fundus pathology. RE adnexa was normal whereas the left eye showed a small abscess forming at the junction of the medial 1/5th and lateral 4/5th of the left lower lid along the orbital margin.
Fluctuation was elicited. A provisional diagnosis of lacrimal abscess was thought of there being no regurgitation from the sac. X-ray of the orbit did not reveal much, but a suspicious linear shadow along the nasopharyngeal area was present
Surgical exploration under G.A was undertaken over the abscess area. First the bluish tinged foreign body was visualized and on deeper exploration a lead like foreign body was seen and on still deeper exploration an impacted foreign body was found and was removed. This foreign body was nothing but a piece of pencil measuring about 2" long [Figure 1]. The surgical wound was closed in two layers Post-operative recovery was uneventful
Case No. II
K D. a 40 years old Female presented with a complaint of recurrent mucopurulent discharge from her left eye for the past 6 weeks following injury with a piece of wood The visual acuity was 6/24 in other eye with early lenticular opacities. No fundus pathology was present RE was normal whereas L E palpebral conjunctiva was congested with lacrimation and abnormal mucopurulent discharge near the medial canthus A provisional diagnosis of intra-orbital foreign body was thought of. X-ray of the orbits did not reveal any radio-opaque shadow. A surgical exploration under local anaesthesia was done, after incising the conjunctiva near the medial canthus along the lower palpebral conjunctiva On deeper exploration a hard object was felt An impacted foreign body was seen between the sclera and the orbital floor and the medial wall. The foreign body was forceblypulled out and it was found to be a 1'/z" long wooden piece [Figure 2]. The surgical area was cleaned and the wound was closed after sprinkling neomycin powder. The post-operative recovery was uneventful.
Case No. III
A small boy had an injury to the RE with a fishing rod needle He was seen in the emergency room and this needle was stuck near the outer canthus in the orbital cavity. It had entered through the conjunctiva under the skin. There was no perforating injury and the eye ball was normal This foreign body was removed under CA [Figure 3]. Post-operative recovery was uneventful.
Case No. IV
RK aged 32, presented with a complaint of bomb blast injury in the RE. On examination visual acuity was 6/6 in each eye RE had a small laceration on the temporal side-otherwise the eye was normal Fundus was normal LE was normal/ X-ray orbit revealed a foreign body and a double exposure limbal ring X-ray taken in two positions or gaze showed an LO. F E As the fundus was normal, an LO. F.R was not a certainty. Any how exploration was caned out on the temporal side and it was found that a metallic foreign body was lying under the lateral rectus near its insertion - part of it was partially transscleral The foreign body was easily picked up and conjunctiva sutured Post-operative recovery was uneventful.
These were cases of intra-orbital foreign body leading to recurrent abscess formation along the lower lid in one and recurrent conjunctival mucopurulent discharge from the other. The third was an intra-orbital foreign body. The peculiar feature was that there was no injury to the globe in spite of large size of the impacted foreign body, two of them being made of wooden material and the other two of steel. A similar case report of infra-orbital foreign body was reported by Dr. J. N. Rohatgi et al (1965) . There the foreign body was lying in the floor of the frontal sinus with a fistula communicating with the orbit and the upper lid Macarae  (1979) also reported a similar case, where a wooden foreign body was lodged 15 mm from the limbus along the inferior rectus. The FB was in contact with the sclera and remained encapsulated This produced a similar recurrent abscess formation Sacks and Matheson  (1962) reported a similar case Panda et al  (1985) also observed discharging sinuses of a long duration in impacted extra-ocular foreign body cases.
In such cases with a history of orbital injury and recurrent pus discharge exploration of the injured area must be thought of. X-ray may or may not reveal a FR depending upon whether it is radio opaque or not In spite of the X-ray being negative and discharge persisting from the area even after antibiotic treatment it is imperative that a surgical exploration must be undertaken carefully.. Any injury on the globe should also be looked for and repaired At times there may be a false positive limbal ring double exposure suggesting IOFB but without any fundus change suggesting exploration of the area
|1||Rohatgi, J.N., et al (1965) Journal Laryng. & OtoL78: 1125-1127|
|2||John A Macarae (1979), BJO, Vol. 63, 848, 851|
|3||Ian Sacks and AT. Matheson (1962), BJO, 46, 304 |
|4||Pande, A Bhatia, LM & DayaL Y. (1985), Afro- Asian Journal of Op. IIL 163|