Indian Journal of Ophthalmology

BRIEF REPORT
Year
: 2004  |  Volume : 52  |  Issue : 1  |  Page : 64--65

An unusual intraorbital foreign body.


V Singh, A Kaur, S Agrawal 
 Department of Ophthalmology, King George's Medical College, Lucknow, India

Correspondence Address:
V Singh
Department of Ophthalmology, King George«SQ»s Medical College, Lucknow
India

Abstract

A plastic foreign body penetrating the anterior base of skull through the orbit in a 10-year-old male child is reported.



How to cite this article:
Singh V, Kaur A, Agrawal S. An unusual intraorbital foreign body. Indian J Ophthalmol 2004;52:64-65


How to cite this URL:
Singh V, Kaur A, Agrawal S. An unusual intraorbital foreign body. Indian J Ophthalmol [serial online] 2004 [cited 2022 Aug 12 ];52:64-65
Available from: https://www.ijo.in/text.asp?2004/52/1/64/14626


Full Text

Ocular injuries are an important cause of preventable visual morbidity in all age groups. Frequently, injuries sustained by children are serious enough to leave a functional residual deficit for the rest of the child's life. Paediatric ocular injuries are largely accidental and sustained at home or at play.[1],[2] Apparently innocuous household appliances can be an important cause of ocular injury. Many of these appliances are made of materials which can be difficult to localize radiologically. [3],[4],[5],[6],[7],[8]

We report one such unusual injury in a child by a plastic ball point pen.

 Case report



A 10-year-old boy sustained accidental trauma to the right eye by a ballpoint pen while playing in the classroom. The boy was not able to recall the type of pen and the mode of injury. He presented 12 hours after the injury with retracted right upper lid, congested chemosed conjunctiva, proptosis and inferior displacement of the right globe. There were no ocular movements and the cornea had exposure keratopathy. The right eye had no light perception; pupillary reaction to light, both direct and consensual, were absent. Details of anterior chamber and posterior segment could not be seen. There was no obvious palpable foreign body. The entry wound of the foreign body could not be identified due to the retracted upper lid margin and the chemosed conjunctiva [Figure 1].

A retained intraorbital foreign body was suspected. An X-ray skull PA view revealed only a breach in the roof of the right orbit. The radiograph did not show any obvious radio-opacity or radio-lucency. Non-contrast CT scan of the head and orbit (axial and coronal cuts) showed a dense radiolucent shadow, conical in shape with its apex in the anterior cranial fossa and base in the right orbit [Figure 2]. Ultrasonography of the orbit demonstrated a normal posterior segment with retrobulbar haemorrhage with some interface echogenicity.

Exploration was done under general anesthesia. On pulling the relaxed lid and retracting the chemosed overhanging conjunctiva through the entry wound of the suspected foreign body, the broken end of the plastic object was felt in the superior -lateral quadrant of the right orbit. Further blunt dissection exposed the broken end of a plastic object. No fresh incision was given. Presuming that this was part of the pen mentioned in the history, a pair of mosquito artery forceps was introduced into the lumen of the plastic foreign body. It was clamped and pulled out in the direction suggested by the shadow in the CT scan [Figure 2]. The transparent foreign body, the front portion of a plastic ball pen was 6 cm long and 1 cm wide. The upper lid was sutured as per the tissue planes and repositioned.

One week after surgery the CT scan showed resorption of the air and sealing of the base of anterior cranial fossa wound by dura. One month post surgery the eye showed significant clearing of the cornea and surprisingly, vision of counting fingers at 4 meters with a full projection of rays. Fundus examination by indirect ophthalmoscopy revealed temporal pallor at the optic disc with no other fundus abnormality.

 Discussion



Plastic, wood and air have radiologically similar characteristics and can be very difficult to distinguish.[4],[7] Air, when trapped inside a foreign body, will take a shape conforming to the primary object.[7] This is an important clue to the presence of a foreign body. In this case the conical radiolucent shadow suggested the presence of air in the conical foreign body. Glass can be localized on the CT scan due to its lead content.[6],[8] Ultrasonograophy gives us information about interface echogenicity only. [3],[5] These foreign bodies do not have any specific imaging characteristics.

This case illustrates the ocular hazards of careless handling of even benign objects. This calls of exercise of care and caution to prevent any kind of trauma to the eye.

References

1Strahlman E, Elman M, Daub E, Baker S. Causes of pediatric eye injuries. A Population based study. Arch Ophthalmol 1990;108:603-6.
2MacEwen CJ, Baines PS, Desai P. Eye injuries in children: The current picture. Br J Ophthalmol 1999;83:933-36.
3Simonton JT, Arthurs BP. Penetrating injuries to the orbit. Adv Ophthalmic Plast Reconstr Surg 1988;7:217-19.
4Wesley RE, Anderson SR, Weiss MR. Management of orbital-cranial trauma. Adv Ophthalmic Plast Reconstr Surg 1987;7:3-8.
5Cobb SR, Yeakley JW, Lee F. Computed tomographic evaluation of ocular trauma. Comput Radiol 1985;9:1-9.
6Coleman DJ, Rondeau MJ. Diagnostic imaging of ocular and orbital trauma. In: Shingleton BJ, Hersh PS, Kenyon KR, editors. Eye Trauma . St. Louis, Mosby-Year Book, 1990. pp 140-62.
7Fuller DG, Hutton WL. Prediction of postoperative vision in eyes with severe trauma. Retina 1990;10:S20-22.
8Etherington RJ, Hourihan MD. Localization of intraocular and intraorbital foreign bodies using computed tomography. Clin Radiol 1989;40:610-15.