Delayed Presentation of Orbito-Cerebral Abscess Caused by Pencil-Tip Injury

Abstract

This report describes the clinical and radiologic findings of a child who was stabbed with a pencil tip in his right upper eyelid, in what initially appeared to be an innocuous injury. The child presented again 3 weeks later with a combined orbital and frontal lobe brain abscess. The mechanism of injury is discussed, the orbital and neuro-surgical interventions are detailed, and the medical treatment is presented. Ophthalmologists should have a high index of suspicion for orbital foreign bodies and possible intracranial injury in cases of penetrating eyelid trauma.

Suspected Endothelial Pencil Graphite Deposition

“…It may also lead to corneal microcysts, chronic anterior chamber reaction, keratitis, and even orbitocerebral abscesses. Due to its similar appearance with herpetic keratitis, these cases were usually treated with antiherpetic treatments as discussed elsewhere [2, 3, 5, 6]. …”

A delayed frontorbital abscess caused by a penetrating nonmissile foreign body (A bamboo stick)

“…Children are more often injured through this mechanism because their orbital bones are more fragile than that of adults. [5] The orbital wounds often appear trivial with a tiny entry point [ Figure 1b], which occasionally is not even visible. This fact together with a good Glasgow coma scale (GCS) makes it difÞ cult to estimate the extent of the injury.…”

Pencil in the Brain: A Case of Temporal Lobe Abscess following an Intracranial Penetrating Pencil Injury

“…The majority of the cases are delayed, presenting 3 days to 3 weeks after the injury and sometimes even after years [1,4]. Most injuries appear subtle or trivial on the exterior and a high degree of suspicion has to be maintained in such cases.…”