Intraorbital foreign bodies – 5 own cases and review of literature

Abstract

Five patients were surgically treated for intraorbital foreign body: a 14-year-old girl had a door glass splinter, a 23-year-old man a metallic foreign body--gunshot pellet, a 55-year-old man a splinter from a metallic bar, a 48-year-old patient the splinters of circular saw and 61-year-old man with shot. Two foreign bodies were removed using the Krönlein-Reese-Berk lateral orbitotomy, two others by Sewell medial orbitotomy and one with superior orbitotomy of Dandy-Naffziger. Radiographs and CT scans were used to identify and localize intraorbital foreign bodies. In one case we found coexistence foreign body (shot) and tumor--inflammation pseudotumor of the orbita. It is possible, that in this case long-time occupy foreign body in the orbita was a cause of that tumor. All foreign bodies were successfully removed, and postoperative course was uneventful. The Krönlein-Reese-Berk orbitotomy provides a satisfactory access to the lateral and posterior orbit, which is of particular importance in the case of a deeply penetrating foreign body (metallic or glass). Surgical removal of intraorbital foreign bodies is a classic example of an interdisciplinary therapeutic approach. Best outcome is usually a result of a team of an ophtalmologist, ENT surgeon, maxillary surgeon and possibly also neurosurgeon performing the operation.

Intraorbital penetrating and retained foreign bodies –a neurosurgical case series

“…Though some cases appear to be routine, special attention must be given to remnant foreign bodies because underestimating trauma can have dangerous or potentially life-threatening consequences (5), including vision loss due to lesions of the eye ball, optic nerve, or their vasculature (8); lesions of the abducens or oculomotor nerves (26); orbital inflammation (2); orbital fistula (38); orbital compartment syndrome (18); or even pneumocephalus or meningitis (13). As clinical signs at the anterior surface of the orbit can be sparse (29), nonspecific such as in orbital cellulitis (17), or present late after the orbital trauma when the entry wound is healed (22), the presence of an intraorbital foreign body should be suspected in every case of orbital trauma, and this diagnosis should be confirmed or excluded on imaging.…”

Foreign Body in the Orbital Floor: A Case Report

“…Most eye injuries as in our case, involve the penetration of a foreign body, exhibit minimal surface damage, which may often be undervalued by the physician during the initial evaluation [3]. Orbital fat tends to conceal the trajectory, making it difficult to identify a point of entry.…”

Self-sealing posterior scleral perforation in airgun ocular trauma, surgical tip: a case report

“…Foreign bodies can reach the orbital space because of bulbar double perforation or via lid lacerations through peribulbar tissues. In the latter way, as the globe integrity is maintained, visual acuity is preserved [6][7][8].…”