A Case of an Intraorbital Wooden Chip Foreign Body Diagnosed and Removed Several Months after Injury Despite Repeated Imaging Study

Abstract

Intraorbital foreign bodies due to trauma are commonly encountered in clinical practice. However, organic foreign bodies, such as wood chips, can sometimes be difficult to diagnose. Here, we report the case of a patient with a wooden chip located intraorbitally that was not detected until spontaneous discharge, despite repeated diagnostic imaging. A 43-year-old intoxicated woman presented to our hospital with a bruised face and eyelid. The patient was diagnosed with conjunctivitis and iritis, but no foreign body was noted in repeated imaging studies since the first visit. Therefore, the patient was observed and managed conservatively. The patient returned to the hospital 114 days after the injury, with no improvement in her conjunctivitis. Examination revealed exposure of a foreign body in the lower eyelid conjunctiva, which was removed during emergency surgery. There are no clear criteria for imaging diagnosis of organic foreign bodies in the body. However, it may be possible to detect them by changing the imaging conditions and examining the computed tomography values in detail. In addition, in case of persistent clinical symptoms, such as inflammation, the image examination should be reviewed. In eyelid trauma, the medical history is sometimes unknown, so it must be remembered that a detailed examination and, in some cases, clinical symptoms are important in making a diagnosis.

Extracted Intra-Orbital Wooden Foreign Body Missed by the Primary Clinician

“…To supplement this information, we conducted a review of studies published between 2016 and 2022 using PubMed and analyzed the symptoms of 30 patients diagnosed with an IOWFB. Our findings demonstrated the prevalence of the following symptoms: decreased visual acuity (16/27 cases), limited ocular motility (11/23 cases), proptosis (9/18 cases), the elevation of intraocular pressure (11/19 cases), swelling of the eyelids (25/28 cases), conjunctival congestion (11/11), and diplopia (3/3) 1,7,8,11,[13][14][15][16][17][18][19][20][21] . Although some of these findings are non-specific, limited ocular motility, proptosis, and the elevation of intraocular pressure can be relatively specific findings of intra-orbital diseases.…”

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

“…In addition, secretions and pus need to be collected for further bacterial culture to select effective antibiotics based on the culturing results. Many pathogenic microorganisms can lead to infections, of which Staphylococcus and Streptococcus are commonly seen [32][33][34] . In the postoperative period, systemic broad-spectrum antibiotics are essential for preventing and controlling orbital infection [35] .…”