Indian Journal of Ophthalmology

CASE REPORT
Year
: 1995  |  Volume : 43  |  Issue : 4  |  Page : 195--196

Retained wooden foreign bodies in the orbit: A case report


Deepak Kumar, Sandeep Saxena, Upsham Goel 
 From the Department of Ophthalmology, King George's Medical College, Lucknow, India

Correspondence Address:
Deepak Kumar
From the Department of Ophthalmology, King George«SQ»s Medical College, Lucknow
India




How to cite this article:
Kumar D, Saxena S, Goel U. Retained wooden foreign bodies in the orbit: A case report.Indian J Ophthalmol 1995;43:195-196


How to cite this URL:
Kumar D, Saxena S, Goel U. Retained wooden foreign bodies in the orbit: A case report. Indian J Ophthalmol [serial online] 1995 [cited 2021 Apr 16 ];43:195-196
Available from: https://www.ijo.in/text.asp?1995/43/4/195/25251


Full Text

The orbital cavity can lodge unexpected foreign bodies. They often remain within the orbit for a considerable length of time, without causing troublesome symptoms and signs. However, after an initial quiescent period complications often arise. There may be granuloma, orbital cellulitis, orbital abscess, osteomyelitis, periostitis, or chronic draining fistula through the conjunctiva or skin.[1] A wooden orbital foreign body may present considerable diagnostic difficulty due to its location within the orbit and due to its relative translucency.[2][3][4] With the advent of orbital computed tomography (CT) scanning or ultrasonography, the likelihood of its identification has increased.

An unusual case of retained wooden foreign bodies in the orbit is being reported.

 CASE REPORT



A 22-year-old male sustained injury to his left eye by a wooden stick, as he bent to pick some object. Following the injury, he developed pain, redness, lid swelling, drooping of upper eye lid, loss of movements and loss of vision in his left eye. He was treated elsewhere where bits of wooden pieces were removed from his left eye and topical antibiotics were advised. When the ocular symptoms persisted even after six weeks of treatment, he was referred to this hospital.

On examination, unaided visual acuity in his right eye was 6/9 (Snellen's chart) and his left eye showed no perception of light. Intraocular pressure of both the eyes was normal. Examination of the left eye and orbit revealed a 3-mm axial proptosis by Hertel's exophthalmometer, ptosis with total ophthalmoplegia, loss of sensations, conjunctival congestion and chemosis, granulation tissue inferotemporally adjacent to the globe, fixed and dilated pupil, and primary optic atrophy [Figure:1]. X-ray orbit did not show any foreign body or bony lesion.

It was decided to explore the granulomatous area. Under local anaesthesia, two pieces of wood measuring 5.1 x 0.7 cm and 4.5 x 0.5 cm were removed. However, during their removal they broke further [Figure:2]. Subsequently, lid oedema, proptosis and conjunctival chemosis regressed but ptosis, ophthalmoplegia and vision did not show any improvement.

 DISCUSSION



The present report traces the clinical course of a patient who sustained an eye injury which resulted in undetected wooden foreign bodies in his left orbit for a period of six weeks. The immediate loss of vision, development of ptosis, loss of ocular movements and proptosis was, however, suggestive of more grievous nature of injury. It appeared that loss of vision was either due to direct injury to the optic nerve or due to haemorrhage in the optic nerve sheath which finally resulted in primary optic atrophy. The development of ptosis and ophthalmoplegia could be explained as a direct injury by the foreign body to the structures passing through the superior orbital fissure, supplemented by orbital cellulitis. The granulation tissue situated inferotemporal to the globe attracted our attention to explore that area which ultimately led to the removal of two wooden foreign bodies. CT scan could have been helpful in localising the retained orbital foreign bodies and in knowing the status of the optic nerve.

Long and multiple foreign bodies in the orbit following an apparently trivial trauma is rare. Single pieces of wood 3.5 cm and 7.0 cm long retained for 40 days and 60 days, respectively[1] and 2.4 cm long wooden piece retained for 14 weeks have been reported. In the present case, two pieces of wood measuring 5.1 cm and 4.5 cm, respectively were retained for six weeks. The possibility of such retained multiple foreign bodies in the orbit must be considered in an injury caused by organic material, particularly when signs of inflammation persist after routine therapy.

References

1Bhaskararajan G, Danodaraswamy M, Sivasubramaniam P, Thiyagarajan S. Orbital foreign body - Case reports. Indian J Ophthalmol 30:53-55, 1982.
2Von Marton D. Foreign body in the orbit. Ophthalmologica 159:49-54, 1969.
3Legras M, Lecoq PJ. Orbital wounds with retention of foreign radio-transparent bodies. Arch Ophthalmol Rev Gen Ophthalmol 30:57-60, 1970.
4Ferguson EC. Deep, wooden foreign bodies of the orbit. A report of two cases. Trans Am Acad Ophthalmol Otolaryngol 74:778-787, 1970.