Clinical Presentation and Management Strategies in Intraorbital Foreign Bodies
Table 1
Summary of clinical profile and management outcomes of cases with IOrbFBs.
No.
Age/sex
Nature of FB (location)
Mode of injury
Time between injury and presentation
Presenting features
Investigation
BCVA
Treatment/surgical findings
Status at last follow-up (duration)
1
4 y/M
Plastic FB (medial extending up to the apex)
Trauma while playing with pen
5 months
Right: Chronic discharging sinus at the medial canthal region with orbital cellulitis
CT: linear nonmetallic foreign body extending up to the posterior orbit. MRI: not done. Culture: Staphylococcus aureus
OD: not following light. Fundus suggestive of optic atrophy OS: following light. Refraction suggestive of hyperopia (+5D)
Intravenous antibiotics given Surgical removal of the plastic FB done
OD: not following light EOM OU: full and free Discharging sinuses with orbital cellulitis resolved (5 months)
2
10 y/M
Plastic FB (inferior orbit, extending up to the apex)
Trauma while playing with pen
10 days
OD: traumatic superior orbital fissure syndrome with traumatic optic atrophy Entry wound seen 6 mm below the right lower lid margin
Initial CT inconclusive Repeat CT: nonmetallic linear IOrbFB ( mm) between the floor and IR extending from the mid orbit to SOF, abutting the ipsilateral optic nerve MRI: FB extending up to the orbital apex abutting the optic nerve associated with right orbital floor fracture and fat herniation
OD: NLP OS: 20/20
Intravenous steroids given for TON Patient refused surgery in view of guarded visual prognosis
BCVA: OD NLP OS: 20/20 EOM OU: full and free Ptosis resolved Fundus OD: optic atrophy (10 months)
3
27 y/F
Metallic FB (inferior)
Gunshot
3 hours
OD: vitreous hemorrhage and limitation of movement in upgaze OS: circumferential limbal perforation with uveal tissue prolapse with NLP
CT: metallic FB in relation to the right orbital floor in close proximity to the IR along with a fracture of the right orbital floor, lateral wall, and medial wall. Comminuted fracture of frontal bone along with roof, medial wall, and floor of the left orbit. MRI: not done
OD: 20/200 OS-NLP
OD: surgery deferred Conservative management done OS: evisceration
BCVA: OD 20/40 OS: prosthetic eye EOM OD: full and free No significant enophthalmos noted (1 year)
4
30 y/M
Metallic FB (medial)
BB injury
6 hours
Referred for ophthalmic evaluation in view of BB injuries at multiple sites. Asymptomatic with entry wound at left glabellar area
CT: metallic FB in the anterior orbit adjacent to the medial rectus
OU: 20/20
Surgical exploration done. Intraoperative canalicular injury noted. Repair with silicon intubation done. FB could not be retrieved intraoperatively. Postoperative CT suggestive of posterior migration. No further surgical intervention done
Asymptomatic OU: 20/20 EOM OU: full and free Syringing: patent (6 months)
5
35 y/F
Wooden FB (anterior orbit extending up to the posterior orbit)
Undetermined
3 years
OS: diminution of vision associated with inferolateral swelling with limitation of extraocular movements in all gazes Left hypotropia with chemosis and congestion noted
CT: posterior orbital mass in the lateral half of posterior orbital fat. MRI: focal well-defined lesion in the posteroinferior aspect of the left orbit between LR and IR muscle with peripheral enhancement postcontrast suggestive of FB granuloma
OD: 20/20 OS: 5/200 PR accurate
Surgical exploration with histopathological examination A, , wooden foreign body removed surgically
BCVA OU: 20/20 EOM OD: full and free OS: improvement in extraocular movements. Left hypotropia present. No diplopia seen Complete resolution of inflammatory signs (2 months)
6
36 y/F
Wooden FB (medial orbit)
Trauma while cutting wooden log
8 months
Left lower lid recurrent abscess Syringing patent
USG: inferior orbital abscess. CT/MRI: not done Culture: sterile
OU: 20/20
Surgical exploration: abscess drainage done. FB found and removed. Postoperative MRI showed no evidence of IOrbFB
BCVA OU: 20/20 EOM OU: full and free Complete resolution of signs and symptoms (1 year)
7
50 y/M
Metallic FB (inferior orbit)
Physical assault with a knife
1 day
OD: pain with entry wound 7-8 mm below the right lower lid margin OS: mature cataract
X-ray and NCCT orbit: suggestive of a linear metallic FB running along the right orbital floor
OD: 20/20 OS: PL positive PR accurate
Successful surgical removal of the linear foreign body (knife) OS: cataract surgery done a few days later
