Orbital and Orbitocranial Trauma From Pencil Fragments: Role of Timely Diagnosis and Management

Cho, Won‐Kyung; Ko, Audrey C.; Eatamadi, Habibullah; Al-Ali, Abdelqadir; Abboud, Jean-Paul; Kikkawa, Don O.; Korn, Bobby S.

doi:10.1016/j.ajo.2017.05.018

Cited by 21 publications

(22 citation statements)

References 15 publications

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“…Whereas they account for 3% of the consultations in emergency departments in the U.S. (10), in our department they occurred in only 2.17% of the orbital pathology, which has a variable percentage from one neurosurgeon to another. Among the orbital trauma cases, they occupied nearly one fifth compared to one sixth of those reported in the literature (8,28). The male dominance, the young age and the working accidents as leading cause of trauma were consistent with other series reported (22,29).…”

Section: █ Discussionsupporting

confidence: 87%

“…In our series, nonmetallic foreign bodies, mostly wooden, were more aggressive than the metallic foreign bodies, leading to a higher prevalence of clinical signs such as palpebral edema, upper lid ptosis, and displacement of the eyeball. They also have a porous structure that enables the growth of microorganisms (8). Infection resulting from retained intra-orbital wooden foreign bodies may lead to complications such as panophthalmitis, abscess, and chronic fistula (35).…”

Section: █ Discussionmentioning

confidence: 99%

“…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.…”

Section: Original Investigationmentioning

confidence: 99%

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Intraorbital penetrating and retained foreign bodies –a neurosurgical case series

Szabo

Paşcalău²,

Bartoè³

et al. 2019

Turkish Neurosurgery

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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.

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Section: █ Discussionsupporting

confidence: 87%

Section: █ Discussionmentioning

confidence: 99%

Section: Original Investigationmentioning

confidence: 99%

See 1 more Smart Citation

Intraorbital penetrating and retained foreign bodies –a neurosurgical case series

Szabo

Paşcalău²,

Bartoè³

et al. 2019

Turkish Neurosurgery

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“…In fact, ocular injuries caused by pencils are not rare in children and include penetration of the eye wall, traumatic cataract, endophthalmitis, and pencil lead retained in the anterior chamber [ 9 ] or posterior segment. Pencil fragments left in the eye after orbital or orbitocranial penetrating injuries can even be life and vision threatening [ 10 ]. Insufficient awareness of such injuries at school may be the cause of these preventable accidents.…”

Section: Discussionmentioning

confidence: 99%

Clinical Features and Surgical Outcomes of Posterior Segment Intraocular Foreign Bodies in Children in East China

Zhang

Zhuang

Wang

et al. 2018

Journal of Ophthalmology

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Purpose To report the long-term follow-up results of posterior segment intraocular foreign body (IOFB) removal in children and to determine the prognostic factors for visual outcome. Methods Design: retrospective, noncomparative, interventional case series; a single tertiary care center study. Participants or samples: eleven eyes (11 patients) under 16 years of age with posterior segment IOFB injuries from May 2014 to November 2017. Main outcome measures: clinical features of injury, visual acuity, and complications. Results The mean age was 6.8 years, and the mean follow-up was 20.2 months. The main IOFB sources were accidental penetration of the eye by materials in the playground (6 cases) or by pencil lead at school (4 cases). The mean IOFB size was 3.8 (range 1–6) mm. At the last visit, the visual acuities were 20/40 or better in 40.0% of patients and better than 20/200 in 70.0%. Poor visual outcome was correlated with intraoperative rhegmatogenous retinal detachment (P=0.0083). Postoperative complications included elevated transient intraocular pressure, retinal redetachment, and secondary glaucoma. Conclusions The clinical features of pediatric posterior segment IOFBs suggest insufficient awareness of such injuries both on the playground and at school. Visual outcomes from surgical treatment were relatively favorable in this series.

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“…Wooden IOFBs can cause a rapidly healing wound at the surface, leaving residual foreign material in the wound and inducing subsequent misdiagnosis. 4 One study showed that non-magnetic low-density IOFBs were misdiagnosed by CT but confirmed by MRI. 5 Wooden IOFBs are hardly detected by CT and occasionally misdiagnosed as air.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of wooden intraocular foreign body by magnetic resonance imaging in rabbits

et al. 2018

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ObjectiveIntraocular foreign body (IOFB), a frequent cause of ocular trauma, causes serious damage to the eyes. This study was designed to elaborate and compare the characteristics of different magnetic resonance imaging (MRI) sequences in detecting wooden IOFBs in rabbits.MethodsThe right vitreous of 24 healthy rabbits was randomly implanted with diverse wooden foreign bodies (diameter φ = 0.2 mm). The T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), proton density-weighted imaging (PDWI), and susceptibility-weighted imaging (SWI) sequences were applied individually 2 weeks after the implantation.ResultsIOFBs were detected as linear low signals on T1WI, T2WI, PDWI, and SWI (SWI image). The detectable rates of poplar wood with a length of 0.5 mm were 0%, 50%, 0%, and 67% for T1WI, T2WI, PDWI, and SWI, respectively. SWI and T2WI sequences exhibited higher sensitivity than T1WI and PDWI. The detectable rates of the first three SWI sequences (magnitude, phase, and SWI) were all 67%, which was higher than that of the minimum intensity projection sequence (33%).ConclusionMRI is practicable in the diagnosis of wooden IOFBs. SWI and T2WI are optimal for the integrated diagnosis of wooden IOFBs and could be used for diagnosis and immediate treatment.

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Orbital and Orbitocranial Trauma From Pencil Fragments: Role of Timely Diagnosis and Management

Cited by 21 publications

References 15 publications

Intraorbital penetrating and retained foreign bodies –a neurosurgical case series

Intraorbital penetrating and retained foreign bodies –a neurosurgical case series

Clinical Features and Surgical Outcomes of Posterior Segment Intraocular Foreign Bodies in Children in East China

Characteristics of wooden intraocular foreign body by magnetic resonance imaging in rabbits

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