Unexpected Finding in Ocular Surface Trauma: A Large Intraorbital Foreign Body (Bullet)

Abstract

Sometimes intraorbital foreign bodies lead to unexpected findings. A 16-year old boy was referred due to ocular surface trauma. A conjunctival laceration was detected at the level of the left caruncle with associated left exotropia, reduced adduction as well as a preretinal hemorrhage along the nasal periphery of the fundus. A blow-out fracture of the medial orbital wall was suspected and a CT scan of the orbits was scheduled which revealed the presence of a large intraorbital foreign body. The removal of the intraorbital foreign body (which proved to be a bullet) and precautionary laser photocoagulation along the nasal periphery of the left eye were performed. Ocular surface trauma may reveal unexpected findings, such as an intraorbital foreign body, requiring investigation by a CT scan.

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.…”

Metallic foreign body in the orbit – case report

“…For this reason, their immediate removal is very important in the prevention of complications, such as abscess, inflammation of the eyeball with loss of vision, inflammation of the optic nerve, meninges, formation of fistulas or sinusitis. [1,2,5,6]. In the presented case, the patient provided information about the exact the circumstances in which the injury was incurred, and the foreign body was partially visible and identifiable in the traumatic wound.…”

“…At the time of the injury, the patient was some distance away after the accident?, which significantly weakened the kinetic energy of the object thrown and did not cause bone tissue injuries (2,3,6). The decision was made to remove the foreign body via the entry wound and under general anaesthetic, in cooperation with an ophthalmologist, using peri-operative local and general antibiotics.…”

“…Small elements can also enter the orbit through closed eyelids, piercing them, which often escapes the patient's attention and sometimes causes further complications (4). The prognosis for this type of injury depends on the location and size of the foreign body, the chemical composition and degree of damage to the surrounding anatomical structures (6). The variety of foreign bodies affects the selection of appropriate radiological diagnostic methods.…”

An Extremely Long Lasting Foreign Body in the Orbital Floor

“…Orbital fractures and meningitis concomitant with loss of vision and possible brain damage inflicted by intraorbital foreign bodies have been reported in the literature. 3,4 The most frequent complications triggered by orbital foreign bodies include proptosis, chronic fistula, orbital abscess, cellulitis, and eye muscle or optic nerve wounds. 3 Diagnosis of orbital foreign bodies is often difficult and depends on the content and size of the foreign body.…”