Considerations for a Retained Foreign Body in the Posterior Orbital Apex

Abstract

Orbital foreign bodies must be approached with complex considerations involving their precise location and composition in order to adequately guide management. Physicians must carefully weigh the advantages and risks of surgical and medical intervention compared to conservative management. We present a case of a male patient with penetrating trauma to the eye that resulted in open globe injury and orbital foreign body, presumed metallic, at the posterior orbital apex near the optic nerve. As such, despite the uncertainty of the exact composition of the object, the medical team and patient agreed to conservative management given its high-risk anatomical location.

Retained large intraorbital metallic foreign body with delayed presentation: An unusual case report

“…A patient with an orbital foreign body may occasionally experience no symptoms since it is an occult foreign body. Patients may present with double vision, discomfort, edema, or visual abnormalities [5]. Our patient remained reasonably asymptomatic for the first 4 months, and then he gradually developed eye tearing, pain, occasional seropurulent discharge, and progressive loss of vision and presented to our neurosurgery department.…”

“…Foreign objects in orbit have the potential to become lodged in the orbital walls, which could cause harm to neighboring structures like the globe, cranial nerves (especially cranial nerves II, III, IV, V, and VI), and extraocular muscles. Even though it's uncommon, an orbital foreign body can enter the orbit right through the globe and settle into the apex [5]. In our case, a large metallic foreign body measuring around 4 × 1.5 cm penetrated through the lateral aspect of the upper eyelid into the posterior aspect of the left orbital cavity and injured the globe with a comminuted fracture at the frontal bone forming the roof of the orbit and zygomatic bone following an incident of RTA.…”