Could Radiographs Be More Helpful in the Removal of an Intraorbital Foreign Body Than a Surgical Navigation System? A Neurosurgical Case Report.

Intraorbital foreign body (IOFB) is a vision-threatening condition that requires careful management. IOFB can manifest clinically from asymptomatic up to severe inflammation and blindness. Diagnosis and treatment are determined by the nature of the IOFB. The type, location, and complications related to the IOFB are taken into consideration when planning the surgery. Here, we report the case of a male in his 20s who was admitted to our clinic with a computed tomography (CT) scan which verified the presence of an IOFB. The patient underwent surgery and the IOFB was removed. Using a surgical navigation system (SNS), it was difficult to pinpoint the IOFB precisely during surgery. We took radiographs with a C-arm to improve our orientation and locate the IOFB. The patient recovered uneventfully, and no issues were noticed one month following surgery. This case report highlights the selection of treatment methods and demonstrates when radiographs can be more helpful than an SNS in the removal of the IOFB.

A Computed Tomography Scan Near Miss of an Intraorbital Wooden Foreign Body.

When intraorbital wooden foreign bodies are missed, the consequences can be devastating. While the gold standard diagnostic imaging is computed tomography (CT), it has low sensitivity. We present a 61-year-old man with a bamboo injury to his right eye. He underwent two CT scans that failed to raise the possibility of intraorbital foreign bodies. Upon additional review, a rectangular-shaped pocket of air was identified in the orbit which was most consistent with wooden foreign bodies based on the clinical history. A combined mid-lid approach followed by a transconjunctival and transcaruncular extension were employed to remove several wooden splinters. Postoperatively, due to recurrent orbital compartment syndrome, he required a second decompression with an inferior rim osteotomy. He had good recovery at 3 months follow-up. Overall, intraorbital wooden foreign bodies are challenging to diagnose due to imaging limitations. Providing a clear history and suspected diagnosis to radiology is critical for diagnosis.

Manquer des corps étrangers intraorbitaires en bois peut avoir des conséquences désastreuses. L'imagerie diagnostique de référence est la tomodensitométrie (TDM) mais sa sensibilité est faible. Nous présentons le cas d'un homme de 61 ans ayant une plaie par morceau de bambou dans son œil droit. Il a bénéficié de deux tomodensitométrie qui n'ont pas réussi à donner l'alarme sur la possibilité de corps étrangers intraorbitaires. Lors d'un réexamen supplémentaire, une poche d'air de forme rectangulaire a été identifiée dans l'orbite; cette poche était très compatible avec des corps étrangers en bois, selon l'histoire clinique. Un abord combiné à mi-paupière, suivi d'une extension transconjonctivale et transcaronculaire, a été employé pour retirer plusieurs échardes en bois. En postopératoire, le patient a nécessité une deuxième décompression avec ostéotomie du bord inférieur en raison d'un syndrome du compartiment orbitaire récidivant. La récupération a été bonne au suivi de trois mois. Globalement, les corps étrangers intraorbitaires en bois sont difficiles à diagnostiquer en raison des limites de l'imagerie. Fournir au radiologue une histoire claire et un diagnostic suspecté est essentiel au diagnostic.

When brakes fail you: Oculocardiac reflex elicited by a retained foreign body in a penetrating orbital injury.

Purpose: To report a case of oculocardiac reflex following penetrating orbital injury with entrapment of extraocular muscle secondary to a retained orbital foreign body. Observation: A 19-year-old man with no known comorbidities presented with a foreign object in his right orbit following a motor vehicle accident. Visual acuity was 20/20 bilaterally with positive relative afferent pupillary defect for the right eye. A motorcycle brake lever was embedded in the right inferotemporal conjunctival fornix, missing his globe. He was bradycardic in the emergency department, with a pulse rate ranging between 45 and 48 beats per minute. An urgent computed tomography scan of the orbit confirmed the penetrating injury with a linear hyperdense foreign body extending from the right inferior orbit into the right maxillary sinus. This foreign body was seen abutting the right lateral rectus and the globe inferiorly. Fractures involving the inferior and medial wall of the right orbit were seen with the inferior rectus, and orbital fat herniated into the maxillary sinus.The patient underwent urgent orbit exploration with foreign body removal and orbital floor repair under general anesthesia. Immediately after removing the foreign body, his pulse rate returned to normal, within 72-80 beats per minute. Six months postoperatively, visual acuity was 20/20 for both eyes. Although he had persistent diplopia on upgaze, he refused any other interventions. Conclusion and importance: Prompt detection of the oculocardiac reflex and removal of the inciting stimulus is vital to prevent any life-threatening events.

Orbital fibrous capsule formation with abscess found 3 years after penetrating injury from a wooden chopstick.

Intraorbital wooden foreign bodies are sometimes difficult to diagnose because of nonspecific clinical manifestations and diversity of imaging characteristics. We herein report a case involving a 72-year-old woman with a history of trauma induced by a coated wooden chopstick 3 years prior. Two years after the incident, computed tomography (CT) scan revealed an intraorbital mass that was initially diagnosed as an intraorbital hemangioma. The patient presented with hyperemia, impairment of ocular movement, and optic neuropathy in her right eye. Magnetic resonance imaging (MRI) showed granulation tissue and an abscess around a foreign body, which was compressing the eyeball. Surgical extraction of the foreign body was performed, leading to resolution of symptoms. The depiction of wooden foreign bodies by imaging is complicated and affected by several factors, increasing the risk of delayed diagnosis. To avoid permanent sequelae, MRI might be helpful because its imaging capabilities are superior to those of CT.

Clinical features, radiological imaging, and treatment strategies of nonmetallic intraorbital foreign bodies: a retrospective analysis.

AIM: To provide comprehensive data on nonmetallic intraorbital foreign bodies (IOFBs) by summarizing and analyzing material types, clinical manifestations, imaging features, and treatment strategies. METHODS: Totally 28 nonmetallic IOFB cases treated at Shengjing Hospital of China Medical University from 2012 to 2020 were retrospectively reviewed. The types of foreign bodies, clinical features, imaging manifestations, and treatment outcomes were analyzed. RESULTS: Among all cases, 67.8% (19/28) of the foreign bodies were organic. The top three entrances were the upper eyelid skin (7/28), lower fornix conjunctiva (6/28), and lower eyelid skin (4/28). In most cases (11/28, 39.3%), foreign bodies remained in the medial orbits. The major clinical manifestations included eyelid redness and swelling (20/28, 71.4%), conjunctival congestion and edema (17/28, 60.7%), and ophthalmoptosis (15/28, 53.6%). Infection was the main complication, which occurred in 57.1% (16/28) of all cases. Computerized tomography (CT) values differed for different foreign bodies and varied in the different periods after injury. The plant- and grease-derived foreign bodies and the surrounding pus cysts showed different signals on magnetic resonance imaging (MRI). The prognosis varied with different foreign body types, surgery timing, and intraoperative management. CONCLUSION: The majority of nonmetallic IOFBs are organic and often remain in the superior, medial, and inferior areas of the orbit. Clinical manifestations vary owing to their different textures. CT and MRI facilitate the identification of foreign body materials. Plant-derived foreign bodies should be completely removed, and surgical treatment is a complicated process.

Plastic orbital foreign body: the rise of plastic and its unintended consequences.

Intraorbital foreign bodies (IOrFBs) are a significant cause of ocular morbidity. Although plastic IOrFBs are rare, the increasing use of plastic and polymer composites in motor vehicles will increase their prevalence. Although challenging to identify, plastic IOrFBs have unique radiographic characteristics. The authors describe a case of an 18-year-old man with a history of a motor vehicle accident and a left upper eyelid laceration. In retrospect, imaging suggested a plastic IOrFB, which was initially overlooked. A follow-up examination demonstrated persistent left upper lid ptosis with an underlying mass. Further work-up revealed a retained IOrFB, which was removed via anterior orbitotomy. Scanning electron microscopy of the material was consistent with a plastic polymer. This case demonstrates the importance of maintaining a high suspicion for IOrFBs in the correct clinical context, the need for increased awareness of plastic and polymer composite IOrFBs, and the use of diagnostic imaging for identification.

A case report of a transorbital penetrating intracranial injury from a motorcycle side mirror metal bar

Objective@#To present a case of transorbital penetrating intracranial injury successfully managed using a stepwise multispecialty approach.@*Methods@#This is a case report.@*Results@#A 26-year-old male presented with a motorcycle side-mirror metal bar impaled into his right orbit. He had a Glasgow Coma Scale (GCS) score of 12. Computed tomography (CT) imaging revealed the metal bar’s trajectory from the right lateral canthus, traversing the superior orbital wall and frontal lobe, resulting in contusion, intracranial hemorrhages and multiple orbital and facial fractures. Despite the severity of the injury, the right globe was found to be intact during intraoperative exploration. The transorbital approach was employed for safe removal of the penetrating object, followed by repair of full-thickness eyelid laceration and transections of the lateral and medial canthi. Subsequently, the Neurosurgery service conducted a right pterional craniotomy, debridement, and duraplasty. Upon discharge, the visual acuity on the right eye was 20/50.@*Conclusion@#Transorbital penetrating intracranial injuries are rare and result in vision loss and life-threatening complications. A transorbital approach in removing a penetrating foreign body can be adopted when injury to cerebral tissues is imminent. Individualizing the management and employing a multispecialty approach can lead to favorable outcomes.

Presentation and Management of a Complex Orbital Apex Syndrome From Penetrating Mechanical Spring Hook: A Case Report.

Our case report demonstrates the management of a unique penetrating orbital injury. The intraorbital foreign body was an approximately 22 cm long metal dishwasher spring hook lodged into the left orbital apex. An ophthalmological check-up a couple of weeks following the removal surgery discerned the patient had an unprecedented case of orbital apex syndrome. We present this unique case so physicians, medical students, and other emergency and medical professionals can learn about the diagnostic, surgical, and multidisciplinary management necessary to achieve a favorable clinical outcome.

A challenging case of an intraorbital foreign body in a child: A case report.

Apart from congenital causes, orbital trauma is a leading cause of unilateral vision loss in children. We report the case of a 2-year-old child who was victim of an orbital trauma of the right eye caused by a ballpoint pen. He consulted us the day after the trauma with significant palpebral edema making the examination difficult. An emergency CT scan of the orbit and brain showed the presence of a right intraorbital foreign body. The patient underwent removal of the foreign body by an anterior orbitotomy with general antibiotic therapy and a simple postoperative course. Penetrating trauma to the orbit should raise the suspicion of the presence of a foreign body. A CT scan should be performed to specify its location. The extraction of the foreign body can be a challenge that requires an experienced surgical team.

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.

Severe Ocular Trauma and the Race Against Time in its Management: A Case Series.

Ocular injury is one of the most important causes of vision loss. We present a case series of different ocular trauma cases with rare presentations which presented a great challenge to emergency management. The management of ocular injuries is a fight against time, with not only the vision but also at times present with the life of patients at risk. These thus require timely diagnosis. The first case involves a sharp penetrating injury with a metallic foreign body in the orbit. The second case is of a retained intraorbital foreign body secondary to a gunshot injury. The third case is of traumatic globe luxation secondary to a blunt injury. Lastly, the fourth case is of an animal bite with a lacerated wound. All the patients in the reported cases presented to the casualty of the Government Medical College, Haldwani. We believe this case series will add to the literature and help ophthalmologists gain experience dealing with such cases.

Detection of Intraorbital Foreign Bodies Using Magnetic Resonance Imaging and Computed Tomography.

PURPOSE: We analyze the detectability of intraorbital foreign bodies (OrbFBs) of various types and sizes using computed tomography (CT) and magnetic resonance imaging using a three-Tesla machine (MRI 3 T). METHODS: An ex vivo model of sheep eyes with preserved extraocular muscles and orbital fat tissue placed in the orbital cavity of the human skull was created for this study. Foreign bodies made of four different materials - plastic, bottle glass, stone and wood - each in three different sizes (large, intermediate and small) were inserted into the soft tissue of the orbit in the extraocular space. Each orbit was scanned by CT and MRI. Images were analyzed by a senior radiologist and underwent masked review by three oculoplastic surgeons. RESULTS: Analysis of MRI and CT scans identified distinguishing characteristics for each of the four materials. This information was further integrated into a clinical algorithm. CT allowed easier identification of most of the embedded materials compared to MRI. Smaller OrbFB size was associated with lower detectability. Review of CT yielded 94.4% agreement between oculoplastic specialists in detecting OrbFbs using CT scans and allowed detection of most OrbFBs. In contrast, the overall agreement with MRI was lower: 66.7% with T1 MPRAGE, 50% with T1TSE, 88.9% with T2 TSE and 72.2% with T2 TSE FS. Plastic was the most difficult material to detect in all size categories. CONCLUSIONS: CT offers a clear advantage over MRI for detecting and localizing nonmetallic OrbFBs of all sizes, except for plastic. Plastic OrbFBs can be detected with CT depending on size but are more visible in MRI scans.

Cuerpo extraño intraorbitario extraído mediante abordaje pterional extradural / Intraorbial foreign body removed by extradural pterional approach

RESUMEN Paciente femenina de 9 años de edad, remitida al Hospital Pediátrico Universitario de Holguín "Octavio de la Concepción de la Pedraja", con el diagnóstico presuntivo de celulitis orbitaria izquierda. Se recoge el antecedente de trauma ocular ipsilateral con objeto de madera hacía un año, por lo que presentó como secuela disminución de la agudeza visual del ojo izquierdo. Al examen oftalmológico presentaba edema y secreciones purulentas a través de trayecto fistuloso en el párpado inferior. Se le realiza ecografía, tomografía computarizada e imagen por resonancia magnética de cráneo y órbitas, con sospecha de cuerpo extraño vegetal. Se decide realizar abordaje pterional extradural, y se logra la extracción de fragmento de madera. Cursa con tratamiento antibiótico con desaparición de las secreciones a las 48 horas del posoperatorio. La evolución ha sido favorable. Los traumas oculares son frecuentes, pero la presencia de cuerpos extraños intraorbitarios son eventos raros que desencadenan un proceso inflamatorio local, cuya magnitud estará en relación con la naturaleza de este. Los estudios imagenológicos son un elemento indispensable para el diagnóstico y la planificación quirúrgica(AU)

ABSTRACT A 9-year-old female patient is referred to Octavio de la Concepción de la Pedraja Children's University Hospital in Holguín with a presumptive diagnosis of left orbital cellulitis. The patient has an antecedent of ipsilateral ocular trauma by a wooden object one year before, which resulted in visual acuity reduction in the left eye. Ophthalmological examination revealed edema and purulent secretion along a fistulous tract in the lower eyelid. Suspicion of the presence of a plant foreign body leads to performance of echography, computed tomography and magnetic resonance imaging of the brain and orbits. It is decided to apply an extradural pterional approach and a wooden fragment is extracted. Antibiotic therapy is indicated and secretion disappears 48 hours after surgery. The patient's evolution has been favorable. Eye trauma is common, but the presence of intraorbital foreign bodies is a rare event that triggers a local inflammatory process whose magnitude will depend on its nature. Imaging studies are indispensable for diagnosis and surgical planning(AU)

Eyelid and orbital trauma for the primary care physician.

Patients who experience trauma to the eyelid or the orbit may present to their primary care providers or directly to the emergency room for evaluation of their injuries. These patients will often be in pain and may have bleeding around the eye, which can make evaluation of these patients difficult. Many traumatic injuries to the eye require quick and immediate intervention. In this article, we will review the background, anatomy, exam and management of some of the most common eye traumas including eyelid lacerations, orbital hemorrhages, intraorbital foreign bodies, and orbital fractures.

Unusual Missed Diagnosis of Foreign Body: A Case Report.

BACKGROUND: Penetrating intraorbital foreign body (IOFB) is usually associated with high-velocity trauma forces around the eye. IOFB injury to globe or optic nerve is considered a surgical emergency; an immediate diagnosis and management plan is generally indicated. METHODS: A case report (design). The patient was a 78-year-old male presented with diminution of vision of the right eye following a high-velocity injury. The patient was noted to have a closed globe injury with associated retinal detachment and vitreous hemorrhage. An initial orbital CT scan did not reveal any IOFB, despite and intact globe. However, repeat a CT head and orbit scan revealed an intracranial magnetic foreign body lodged in the right frontal lobe. CONCLUSION: A CT scan of the brain and paranasal sinuses should be obtained along with a CT orbit in case of high-velocity orbital/ocular trauma.

Extraction of an intraorbital foreign body with the help of an ocular external electromagnet: Instruments of the past still have a place in the present. / Extracción de cuerpo extraño orbitario con ayuda de electroimán ocular externo: instrumentos del pasado tienen cabida en el presente.

Intraorbital Foreign Bodies (IOFB) are objects, usually of metallic nature, located outside the orbit cavity, and can potentially cause serious damage to ocular and orbital structures. The case is presented of a patient with an anterior metallic IOFB that was extracted with the aid of a Livingston-Mansfield ocular external electromagnet. Despite being an instrument «of the past¼, we believe that the electromagnet can still be useful in certain circumstances.

An unusual case of intra orbital foreign body; diagnosis, management, and outcome: a case report.

BACKGROUND: An orbitocranial injury with a penetrating Intraorbital Foreign Body (IOFB) is listed as a rare cause of penetrating trauma. Since this type of trauma is considered a surgical emergency, taking a thorough history along with careful examination to find out the mechanism and cause of the trauma is crucial towards correct diagnosis and management of the disease. CASE PRESENTATION: A 35-year-old male patient was presented to the ER with an occupational craniofacial injury because of an IOFB. The patient underwent an extra-dural orbitocranial craniotomy procedure to remove the foreign body. Interestingly, a plastic foreign body (a piece of a plastic pipe) was removed from the orbital cavity, which was suspected to be a fractured orbital bone, at first place. CONCLUSION: In this study, we demonstrated that plastics could mimic bone structure in a Computerized Tomography (CT) scan leading to possible initial misdiagnosis. Hence high clinical suspicion is necessary for the correct diagnosis of such cases. However, despite the prompt intervention, our patient ended up with permanent vision loss in his injured eye.

[Orbital screwdriver injury in a toddler]. / Orbitale Schraubenzieherverletzung bei einem Kleinkind.

Presentation of a patient with an orbital intracranial penetrating screwdriver injury. The patient had been playing with the screwdriver at the time of the accident, he fell and the screwdriver penetrated his right orbit. Imaging revealed the position of the foreign body, which went from the medial orbital wall, extraconal and medial of the right internal carotid artery, through the sella turcica to the dorsum sellae. The patient had no intracranial hemorrhage. There was hardly any bleeding. The surgical removal of the screwdriver was carried out without complications.

[Penetrating air gun pellet into the orbital apex]. / Penetración de un perdigón en el ápex orbitario.

A foreign body penetrating into the intraconal orbital compartment poses a surgical challenge because of its deep location behind the globe and near the optic nerve. We present a case of an air gun pellet lodged into the orbital apex, which was removed via superolateral orbitotomy through coronal incision. This additional craniofacial technique is a safe procedure to access the lateral aspect of the intraconal compartment in the unusual event of having to remove an orbital foreign body.

Visibility of Different Intraorbital Foreign Bodies Using Plain Radiography, Computed Tomography, Magnetic Resonance Imaging, and Cone-Beam Computed Tomography: An In Vitro Study.

PURPOSE: The study sought to compare the usefulness of 4 imaging modalities in visualizing various intraorbital foreign bodies (IOFBs) in different sizes. METHODS: Six different materials including metal, wood, plastic, stone, glass. and graphite were cut in cylindrical shapes in 4 sizes (dimensions: 0.5, 1, 2, and 3 mm) and placed intraorbitally in the extraocular space of fresh sheep's head. Four skilled radiologists rated the visibility of the objects individually using plain radiography, spiral computed tomography (CT), magnetic resonance imaging (MRI), and cone-beam computed tomography (CBCT) in accordance with a previously described grading system. RESULTS: Excluding wood, all embedded foreign bodies were best visualized in CT and CBCT images with almost equal accuracies. Wood could only be detected using MRI, and then only when fragments were more than 2 mm in size. There were 3 false-positive MRI reports, suggesting air bubbles as wood IOFBs. CONCLUSIONS: Because of lower cost and using less radiation in comparison with conventional CT, CBCT can be used as the initial imaging technique in cases with suspected IOFBs. Optimal imaging technique for wood IOFBs is yet to be defined.