Endoscopic transnasal approach to remove an intraorbital bullet: systematic review and case report.

Introduction: Intraorbital foreign bodies (IOFBs) represent a clinical challenge: surgical management can be controversial and different strategies have been proposed. When removal is recommended, depending on the location and nature of the IOFB both external and endoscopic approaches have been proposed, with significantly different surgical corridors to the orbit and different morbidities. Methods: We performed a literature review of cases of IOFBs that received exclusive endoscopic transnasal surgical treatment to evaluate the role of this surgery in these occurrences. We also present a case of an intraorbital intraconal bullet that was successfully removed using an endoscopic transnasal approach with good outcomes in terms of ocular motility and visual acuity. Results: A limited number of cases of IOFBs have been treated with an exclusive endoscopic transnasal approach. When in the medial compartment, this approach appears to be safe and effective. In our case, two months after surgery the patient showed complete recovery with no significant long-term sequelae. Conclusions: When feasible, an endoscopic transnasal approach for intraorbital foreign bodies represents a valid surgical technique with optimal outcomes and satisfactory recovery.

Trauma and chorioretinal shockwave injury from intra-orbital foreign body.

High-velocity projectile trauma could lead to intra-orbital foreign body and concomitant chorioretinal shockwave injury in the absence of open-globe injury. Management depends on the types, size, and location of foreign bodies.

Removal of Intraorbital Foreign Body by Transnasal Endoscopic Approach Removal of Intraorbital Foreign Body by Transnasal Endoscopic Approach.

Foreign bodies in the intra-orbital area are a rare occurrence. It can be metallic or non-metallic. Intra-orbital foreign bodies can present with a variety of complications depending upon its size and location. We report a case of intra-orbital foreign body which was successfully removed by trans-nasal endoscopic approach.A 12 year old boy with an intra-orbital wooden foreign body in the medial extra-conal space was presented three days post trauma. He had normal visual acuity but there was painful restriction of eye movement. Foreign body was removed and pus drained by trans-nasal endoscopic approach. Post operatively he gradually regained his eye movements. Post operatively patient had complete recovery of eye movements. Traditionally intra-orbital foreign bodies were removed by external approach. With advancement in technology medial intra-orbital foreign bodies can be removed by trans-nasal endoscopic approaches.

Early versus delayed extraction of intraorbital wooden foreign body.

Orbital trauma caused by wooden foreign bodies are relatively uncommon. Both immediate admission and late presentation of wooden trauma may pose a medical challenge to diagnose and manage due to wood can be easily missed on initial imaging. All organic types of intraorbital foreign bodies (IOrbFBs) should be extracted by surgical removal. In this report, we describe two cases of wooden IOrbFBs following penetrating orbital injury at a tertiary eye hospital. The first patient was injured by wood log with early admission, while the second patient presented two months after the injury with penetration by wooden arrow, both involving the sino-orbital. In this case, endoscopic approach is better used to have a more thorough assessment and guided surgery. Eventually, favorable outcomes of both patients can still be achieved. Follow-up is also crucial in patients with intraorbital trauma.

An Eye Capturing Clutch - An Orbital Foreign Body.

Foreign bodies inside the orbital cavity are rare. They may lead to serious complications, depending on their nature, size and mechanism of injury. A 29-year-old male presented with a motorcycle handle embedded in his left orbit, with the vision unaffected. Active wound bleeding, increasing hematoma, a low haemoglobin level, signs of hypovolemic shock, ocular acuity and mobility were investigated. A computed tomography scan revealed a long bent metallic object lodged between the globe and floor of the left orbit with fracture of the medial orbital wall and ethmoidal hemosinus with an intact cribriform plate of the ethmoid. An interdepartmental collaborative effort of Oculoplasty, Oro-Maxillofacial and Neurosurgery were utilized in the removal of the foreign body. The patient recovered well after the surgery and a course of antibiotic therapy. A single large round-tipped foreign body in orbit composed of both metal and plastic is an extremely rare incident and fortunately in our case, was relatively harmless despite its large size. The diagnosis and management of intraorbital foreign bodies must be tailored according to their type and a proper localisation by all possible means, blunt dissection, careful haemostasis aided with good lighting, and exposure helps in their atraumatic removal.

Endoscopy-assisted extraction of orbital and nasal foreign body.

Penetrating orbital injury with a foreign body is a complex problem that requires an interdisciplinary therapeutic approach. Conventionally, an external approach using either transconjuntival or transseptal entry is used by an ophthalmologist. However, there is a risk of damage to the optic nerve and orbital tissue using only the traditional approach. This study concerns a 36-year-old male who has an intra-orbital foreign body (OrbFB). Timely three-dimensional reconstruction computed tomography scan demonstrated an 8-cm-long intra-OrbFB adjacent to the optic nerve penetrating to the contralateral nasal cavity. Endoscopic inspection confirmed a chopstick fragment. Assisted by transnasal endoscopy, the chopstick penetrating from the orbit to the nasal cavity was smoothly removed. Nasal endoscopy is useful for an ophthalmologist in removing foreign body in the orbit.

Long-term ophthalmic anatomical and functional outcomes after surgical removal of intraorbital foreign bodies.

PURPOSE: To analyze the anatomical and functional ophthalmic parameters after the surgical removal of various intraorbital foreign bodies. METHODS: A retrospective analysis of medical records was performed featuring detailed history, ophthalmic examination, orbital computed tomographic scans, treatment details, and outcomes. The analyzed anatomical factors included extraocular movements, the position of the eyeball (proptosis, dystopia, and enophthalmos), and fullness of orbital sulci. The functional assessment was based on visual acuity, pupillary reactions, and diplopia. The outcomes were defined as complete, partial, and failure after a minimum follow-up of 1 year. RESULTS: Of 32 patients, the organic and inorganic intraorbital foreign bodies were surgically removed from 18 (56.25%) and 14 (43.75%) orbits, respectively. At presentation, anatomically the extraocular movement restriction, proptosis/dystopia/enophthalmos, and orbital sulcus fullness were noted in 26 (81.25%), 24 (75%), and 15 (46.88%), respectively. Functionally, diminished visual acuity, diplopia, and pupil abnormalities were seen in 27 (84.38%), 14 (43.75%), and 8 (25%), respectively. After intraorbital foreign body removal at a mean follow-up of 14 months, the improvement of anatomical factors (same sequence) were observed in 8 (30.77%), 20 (83.33%), and 12 (80%), respectively. In functional factors (same sequence), the improvement was noted in none (0%), 13 (92.86%), and 5 (62.5%), respectively. Hence, the majority of patients (n = 20, 62.5%) achieved partial success, while 8 (25%) had complete success. Four (12.5%) had treatment failure despite similar management protocols. CONCLUSION: The anatomical outcomes are better than the functional outcomes after surgical removal of the intraorbital foreign bodies. The visual acuity does not improve considerably after the surgical removal of intraorbital foreign bodies. Overall, the wooden intraorbital foreign bodies have poorer anatomical and functional prognosis.

Delayed Diagnosis of an Occult Wooden Orbital Foreign Body.

An orbital foreign body should be suspected in cases of penetrating orbital injury, but they are not typically seen with low-velocity trauma and no obvious penetrating injury. Wooden foreign bodies are difficult to distinguish from orbital fat on computed tomography (CT), and without a high degree of suspicion for a foreign body, techniques to distinguish wood in the orbit may not be utilized. The authors present here a case of an initially unrecognized wooden orbital foreign body in the setting of orbital trauma where the patient denied any possibility of a foreign body and no evidence of a penetrating injury. The diagnosis was eventually made with an interdisciplinary review of the imaging between the orbital service and radiology, and the foreign body was subsequently removed via orbitotomy. Surgeons should maintain a high index of suspicion when there is a question of a foreign body on imaging, and a low threshold to involve radiology colleagues in the diagnostic evaluation.

Management of Intra-orbital Wooden Foreign Bodies at a Resource-limited Setting in Sub-Saharan Africa.

Introduction: Wooden intra-orbital foreign bodies (IOrbFBs) have a high risk of microbial contamination needing timely diagnosis and treatment. We describe management of three cases of wooden IOrbFB at a resource-limited setting in Liberia. Materials and Methods: This is a retrospective case series of three patients with IOrbFB managed at the Liberia Eye Center, Monrovia, Liberia. Demographic details, mode of injury, ocular examination findings, neuroimaging, surgical treatment, and clinical findings on post-operative follow-up visits were noted for each patient. Results: All the three patients were young, male, and were involved in traumatic incidents (fall in two cases and road traffic accident in one case). Two patients with visible wooden FB presented within 48 h of injury and one patient with occult FB presented after 2 weeks. All patients underwent orbital imaging followed by surgical exploration for the removal of FB. One patient also had coexisting orbital cellulitis, which was successfully treated medically. One of these patients had best corrected visual acuity of 20/20, and the other two had no perception of light in the affected eyes. Conclusion: History of injury with a wooden material should raise a high index of suspicion for an occult IOrbFB. Timely diagnosis and treatment of wooden IOrbFB can be challenging in a resource-limited setting, but with a systematic approach they can be treated satisfactorily.

Introduction: Les corps étrangers intra-orbitaires en bois présentent un risque élevé de contamination microbienne nécessitant un diagnostic et un traitement rapides. Nous décrivons la prise en charge de 3 cas de corps étrangers intra-orbitaires en bois dans un pays aux ressources limitées tel quel le Libéria. Matériel et méthodes: Cest une étude rétrospective sur 3 cas de Corps étrangers intra orbitaire en bois prise en charge dans le centre oculaire du Libéria situé à Monrovia. Les détails démographiques, le mode de blessure, les résultats de l'examen oculaire, la neuro-imagerie, le traitement chirurgical et les résultats cliniques lors des visites de suivi post-opératoires ont été notés pour chaque patient. Résultats: Les 3 patients étaient jeunes, de sexe masculin et ont été impliqués dans des incidents traumatiques (chute dans 2 cas, et accident de la voie publique dans un cas). Deux patients avec un corps étranger en bois visible se sont présentés dans les 48 heures suivant la blessure et un patient avec un corps étranger occulte s'est présenté après 2 semaines. Tous les patients ont été soumis à une imagerie orbitaire suivie d'une exploration chirurgicale pour l'élimination du corps étranger. L'un de ces patients avait une acuité visuelle corrigée de 20/20 et les deux autres n'avaient aucune perception de la lumière dans les yeux affectés. Conclusion: La notion de traumatisme par un matériau en bois devrait faire craindre un Corps étranger intra orbitaire occulte. Le diagnostic et le traitement rapides des corps étrangers intra-orbitaire en bois peuvent être difficiles dans un contexte de ressources limitées, mais avec une approche systématique, ils peuvent être traités de manière satisfaisante.

Analysis of missed diagnosis of orbital foreign bodies.

A clinical analysis of diagnosis was performed as well as the management of orbital foreign bodies, to investigate the methods to avoid missed diagnosis. A total of 15 cases of an orbital foreign body was reviewed, and for these cases, the clinical manifestation, imaging data and operative situation were studied. Among the patients, 4 cases turned out to have wooden, 3 metallic, 2 glass, 2 bones, and 4 other foreign bodies. Twelve cases had received debridement and suture before our management, and 1 foreign body was treated more than once. In conclusion, detailed traumatic history and imaging examination are necessary for the diagnosis of orbital foreign bodies, while prompt diagnosis, accurate location and professional surgical skills are important for the treatment.

The last ride of Henry II of France: orbital injury and a king's demise.

Jousting was a popular pastime for royalty in the Renaissance era. Injuries were common, and the eye was particularly at risk from the splinters of the wooden lance. On June 30, 1559, Henry II of France participated in a jousting tournament to celebrate two royal weddings. In the third match, Gabriel de Montgomery struck Henry on the right shoulder and the lance splintered, sending wooden shards into his face and right orbit. Despite being cared for by the prominent physicians Ambroise Paré and Andreas Vesalius, the king died 10 days later and was found to have a cerebral abscess. The wound was not explored immediately after the injury; nevertheless, wooden foreign bodies were discovered in the orbit at the time of autopsy. The dura had not been violated, suggesting that an infection may have traveled from the orbit into the brain. Nostradamus and Luca Guarico, the astrologer to the Medici family, had prophesied the death of Henry II of France, but he ignored their warnings and thus changed the course of history in Renaissance Europe.

Missed Diagnosis of an Intraorbital Foreign Body of Homemade Fireworks Origin: A Case Report.

PURPOSE: We report a rare case of traumatic injury to the eye caused by homemade fireworks in a Chinese juvenile patient with a metal ring left in the orbit after having been sutured at the Emergency Department. METHODS: An 11-year-old boy presented with a traumatic injury to the right eye from homemade fireworks. Following initial assessment involving maxillofacial computed tomography (CT) and suturing at the Emergency Department, he was transferred to our department for further evaluation because of his poor sight 1 day later. On examination, a skin laceration beneath the right eyebrow was noted, but the superior orbit was not fully visible on the maxillofacial CT performed 1 day previously. Therefore, an orbital CT scan was carried out on the second day, which showed a hyperdense ring embedded in the superior border of the orbital wall; the ring was surgically removed. On postoperative day 7, a fundus examination revealed resolving vitreous hemorrhage, blunt traumatic retinal detachment, and a large retinal tear superior to the macula. The patient refused to take surgery for retinal detachment into consideration. Therefore, we opted for oral steroids and careful observation. RESULTS: After 2 months' observation, the large retinal tear had healed and white fibrous scar tissue had developed, and the retinal detachment superior to the macula had reattached itself spontaneously. The patient's vision had further improved to 20/200. During 1 year of follow-up, he remained clinically stable. CONCLUSION: To avoid missing the diagnosis, a complete history of the mechanism of injury and accurate imaging still prove most useful. Complete removal of the foreign body by the emergency physician is necessary because of the ocular toxicity of an iron-containing foreign body. As evidenced by the current case, oral steroids and observation for a period of several months is a management of choice for traumatic retinal detachment and retinal tear superior to the macula associated with homemade fireworks in children.

Imaging in orbital trauma.

Orbital trauma is one of the most common reasons for ophthalmology specialty consultation in the emergency department setting. We survey the literature from 1990 to present to describe the role of computed tomography (CT), magnetic resonance imaging (MRI) and their associated angiography in some of the most commonly encountered orbital trauma conditions. CT orbit can often detect certain types of foreign bodies, lens dislocation, ruptured globe, choroidal or retinal detachments, or cavernous sinus thrombosis and thus complement a bedside ophthalmic exam that can sometimes be limited in the setting of trauma. CT remains the workhorse for acute orbital trauma owing to its rapidity and ability to delineate bony abnormalities; however MRI remains an important modality in special circumstances such as soft tissue assessment or with organic foreign bodies.