An Unusual Transorbital Penetrating Injury and Principles of Management

Abstract

The objective of this study was to present an unusual low velocity transorbital penetrating injury. The study design was a clinical record (case report). A 38-year-old gentleman tripped and fell face first onto the wing of an ornamental brass eagle. This penetrated the inferomedial aspect of the right orbit, breaching the lamina papyracea to extend into the ethmoid sinuses and reaching the dura of the anterior cranial fossa. The foreign body was removed in theater under a joint ophthalmology and ENT procedure. The patient was left with reduced visual acuity in the right eye but no other long-term sequelae. Transorbital penetrating injury presents unusual challenges to investigation and management requiring a multidisciplinary approach to prevent significant morbidity and mortality. If managed well the prognosis is good.

Metallic foreign body in the orbit – case report

“…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.…”

“…The variety of foreign bodies affects the selection of appropriate radiological diagnostic methods. The most frequently used are: classic radiographs, ultrasound, computer tomography supplemented with angiographic examination, and magnetic resonance imaging [3]. It should be remembered that in classical radiography, metallic bodies distort the image by numerous artifacts.…”

Management of a penetrating orbital trauma from an unusual foreign body with associated eye injury

“…Penetrating orbital injuries constitute between 30% and 50% of all orbital traumas;[1] within these cases, it has been found that one of every six patients presents with a foreign body. [23] These types of injuries deserve special consideration because they can cause eye damage, damage to the orbital structures, and even brain damage[34] and can lead to serious sequelae such as vision loss, which in turn can have medicolegal considerations. [156] Most cases arise from unilateral injuries due to traffic accidents, assaults, accidental falls, or workplace accidents and are more frequent in men aged 20–40 years old.…”

“…Diagnosis is based on clinical data, careful exploration of the orbital and ocular regions, examination of visual function, and radiological study using computed tomography (CT). [4910]…”

“…The treatment of these injuries is usually considered an emergency and should be resolved in the first several hours, potentially requiring multidisciplinary collaboration. [451011]…”