Indian Journal of Ophthalmology

CASE REPORT
Year
: 1989  |  Volume : 37  |  Issue : 3  |  Page : 146--147

Orbital wooden foreign bodies-A case report


SM Betharia, Harsh Kumar 
 R.P. Centre for Ophthalmic Sciences, All MS, New Delhi - 110 029, India

Correspondence Address:
S M Betharia
R.P. Centre for Ophthalmic Sciences, All MS, New Delhi - 110 029
India

Abstract

A case of multiple wooden foreign bodies is presented. Any case presenting with a history of injury and a discharging sinus with osteomyelitis warrants a thorough exploration of the orbit. Anterior orbitotomy was performed and 4 pieces of arhar sticks were taken out. The guidelines for the management of the wooden foreign bodies are highlighted.



How to cite this article:
Betharia S M, Kumar H. Orbital wooden foreign bodies-A case report.Indian J Ophthalmol 1989;37:146-147


How to cite this URL:
Betharia S M, Kumar H. Orbital wooden foreign bodies-A case report. Indian J Ophthalmol [serial online] 1989 [cited 2021 Apr 10 ];37:146-147
Available from: https://www.ijo.in/text.asp?1989/37/3/146/26065


Full Text

 CASE REPORT



A 9 year old child presented with the history of injury 3 years ago with a discharging sinus in the right upper lid with extrusion of 2 small wooden foreign bodies. The injury was with an arhar stick while working in the field. The wound was explored 4 months later and no foreign body could be detected in the local hospital.

O/E - The visual acuity was 6/6 in both eyes. The ocular movements were normal. There was proptosis of the right eye. The right eye was displaced downwards and laterally. There was no bruit and the proptosis was not reducible. There was discharging sinus in the medial part of the upper lid 12 mm from the medial canthus and 1.5 mm from the lid margin. The margins of the sinus were Tuckered and there was crusting on the skin.

Fibrous bands were felt under the area of the sinus. There was cicatricial ectropion involving the medial 1 / 2 of the upper lid. The upper punctum was everted and displaced laterally. Bell's phenomenon was good. Exo­phthalmometry showed a proptosis of 6 mm in the right eye. There was a paramedian tarsorrhaphy in the right eye. Fundus was within normal limits.

 INVESTIGATIONS



Routine haemogram and urine examination was normal. The culture and sensitivity of the discharge from the sinus was positive for staphylococcus epidermidis sen­sitive to cloxacillin. Fungal culture was negative. Radio­logical examination of the orbit- did not reveal any foreign body. CAT was done with 4 mm cuts both in axial and coronal sections revealed only the presence of granulomatous mass and no foreign body could be detected. Ultrasonography did not reveal the presence of the foreign body.

As the sinus continued to discharge inspite of the proper antibiotic therapy a foreign body was suspected [1],[2] and the case was taken up for exploratory anterior orbito­tomy. During the exploration from the area of the sinus, after going deep towards the roof of the orbit, wooden foreign bodies were seen and were taken out with the help of the forceps. These were embedded in the soft tissue. 4 large pieces of the arhar sticks were taken out. The wound was then closed in layers after proper cur­retage of the sinus and carbolic acid cauterization. The puckered skin was excised and the edges of the skin were freshened before closure of the skin wound. The patient was put on systemic antibiotics and antiinflam­matory drugs. The postoperative course was unevent­ful and visual acuity and ocular movements were within normal limits.

 DISCUSSION



The common causes of the discharging sinus in the upper lid near the orbital margin are tuberculosis, fun­gal or bacterial osteomyelitis and the retained intraorbital foreign bodies [3],[4]. This case presented with the history of extrusion of small foreign bodies (arhar sticks). The radiological investigations like X-rays and sophisticated tools like C.T. scan and ultrasonography failed to reveal the presence of a foreign body [5]. A foreign body was suspected because of continuous discharge and explora­tory anterior orbitotomy was done which revealed multiple foreign bodies in the orbit. It is well known that the wooden foreign bodies cause granulomatous reac­tion and infection to give rise to discharging sinus and osteomyelitis. Normally, orbital exploration is not done for foreign bodies not exciting a granulomatous reac­tion, like lead - pellet, glass - pieces etc. which are the common foreign bodies found in the orbit after acci­dents. One has to carefully weigh the pros and cons of exploration of the orbital foreign bodies especially in relation to good visual acuity and ocular movements in the given case, so as to prevent damage to visual acuity and the ocular movements causing diplopia [6]. In this case the successful removal of the foreign bodies was done without any damage to visual acuity and ocular movements. The proptosis however remained due to excessive granulomatous tissue present in the orbit.

Curretage and cauterization with carbolic acid and sub­sequent lavage with saline and antibiotic solution is a must in every case before wound closure is done. Excision of the necrotic and friable walls and the track of the sinus should be done for better healing of the wound. The shortening of the skin giving rise to ectropion is dealt with at a later date, by split-thickness-skin grafting for the upper lid to retain the suppleness of the upper lid skin and to facilitate the normal movements of the upper lid.

References

1Smith, B.C. Ophthalmic plastic and reconstructive surgery. Vol. 1, page 523. The C. V. Mosby Company, St. Louis, 1987.
2Brock, L. and Tannenbaum, H.L. Retention of wooden foreign bodies in the orbit. Can. J. Oghthalmol. 15:70,1980.
3Ferguson, E.C. III. Deep, wooden foreign bodies of the orbit: A report of two cases. Trans. Am. Acad. Ophthalmol. Otolaryngol. 74:778,1970.
4Macrea, J.A. Diagnosis and management of a wooden orbital foreign body. Brit. J. Ophthalmol. 64:848,1979.
5Mandelcom, M.S. and Brown, M. Computed axial tomography localization of intraorbital foreign body. Can.]. Ophthalmol. 13:213, 1978.
6Wesley, R.E. Management of wooden foreign bodies in the orbit. South Med. J. 75:924,1982.