Intraorbital penetrating and retained foreign bodies –a neurosurgical case series

Abstract

AIM: To present the particularities of the intraorbital foreign bodies from a neurosurgical perspective by summarizing the findings of a case series. MATERIAL and METHODS: A retrospective study was conducted including a consecutive series of 30 patients with intraorbital foreign bodies treated between 1999 and 2017. Statistical analysis was performed in order to characterize the factors that influence the location of the foreign bodies and the clinical signs. RESULTS: The orbital trauma occurred mostly in working accidents. Multiple intraorbital foreign bodies were found in 23.3% of the patients. Metallic foreign bodies were seen in 66.6%, and 30% had wooden foreign bodies. Nonmetallic foreign bodies were significantly associated with displacement of the eyeball, palpebral oedema and upper lid ptosis. Posterior orbit location was associated with displacement of the eyeball and conjunctival hemorrhage. Intraconal location was associated with mydriasis and conjunctival hemorrhage. The posterior orbit was occupied by foreign bodies in 63% of the patients. The foreign bodies were in the extraconal compartment in 55.55% of the cases. Small foreign bodies tend to be retained in the anterior orbit while large ones tend to be retained in the posterior orbit. CONCLUSION: The diagnosis and management of intraorbital foreign bodies must be tailored according to their type and location and to the clinical aspect of the patient.

Management of a large intraorbital wooden foreign body: Case report

“…An IOFB is defined as an object located inside the bony orbital walls, posterior to the orbital septum but outside the ocular globe, [8,10] Its position can be extraconal or intraconal, [10] and it can be classified as metallic or nonmetallic; in turn, nonmetallic IOFBs can be organic or inorganic. [10] Intraorbital wooden foreign bodies (IOWFBs) predominantly affect the male population with a mean age ranging from 21 to 22 years in some of the largest series [1,9] similar to our case of a 23-year-old male.…”

“…Larger neurosurgical case series that report the characteristics in terms of diagnosis and treatment of different categories of foreign bodies, according to their material and location in the orbit, as a reference for neurosurgeons who encounter this pathology is very rare. [8] Whereas they account for 3% of the consultations in emergency departments in the U.S the organic foreign bodies, especially wooden ones are linked to a high risk for bacterial and fungal infections, inflammatory granuloma formation, and calcification. Wooden foreign bodies are particularly difficult to remove due to their soft structure, making them prone to fracture during extraction with the risk of remnant fragments and consequent infection.…”

“…In our cases, the entry wound was located primarily on the eyelids. [8] According to the material, the metallic foreign bodies leaved entry wounds the most frequently in the conjunctival fornix, while all the non-metallic foreign bodies penetrated the eyelids.…”

“…ese include: anterior transpalpebral approach, anterior transconjunctival approach, lateral approach, superior transfontanel, and transnasal endoscopic removal which has been described as safe, less damaging, and easy because it gives you direct visualization. [7,8] Ultrasound guidance has also been reported.…”

Tratamento cirúrgico de celulite orbitária e trismo causada por corpo estranho intraorbitário

“…Lesões de alta velocidade podem levar à ocorrência de um corpo estranho intraorbitário (Moraes et al, 2015), essa lesão ocular é incomum e ocorre com uma frequência aproximadamente de 16% de todas as lesões orbitais (Chen et al, 2015;Cho et al, 2017;Mirzaei et al, 2019;Tabibkhooei et al, 2019;Mohapatra et al, 2020). O corpo estranho intraorbitário é geralmente relacionado a acidentes envolvendo trauma penetrante de alta velocidade (Moraes et al, 2015;Blackhall andLaraway., 2016 Mirzaei et al, 2019;Szabo et al, 2019) e tipicamente acometem homens, crianças e adultos jovens (Mirzaei et al, 2019;Szabo et al, 2019). A gravidade do trauma é avaliada em relação à velocidade e trajetória do objeto, normalmente causada por quedas, agressões ou colisões de veículos a motor (Tabibkhooei et al, 2019).…”