Intraorbital Organic Foreign Body—A Diagnostic Challenge

Abstract

Intraorbital organic foreign bodies pose a diagnostic and management challenge to ophthalmologists. A high degree of suspicion of an orbital foreign body is needed when patients present with injuries to the eyelids and orbit. We present a case of retained intraorbital wooden foreign body which was initially undetected. A 10-year-old boy presented to the eye casualty with signs and symptoms suggestive of orbital cellulitis. He was started on intravenous antibiotics and urgent CT of the orbits did not reveal any foreign bodies. There was spontaneous extrusion of a wooden foreign body through the upper lid two days later, followed by spontaneous resolution of symptoms. Wood has a density similar to air and fat and can be difficult to distinguish from soft tissue in both a plain X-ray film and a computed tomogram. Clinicians should be alerted to the possibility of retention of an intraorbital foreign body in all patients presenting with periorbital trauma. The clinician should also obtain a careful history of the type of injury and should examine the patient in detail. In cases where a wooden foreign body is suspected, investigation by magnetic resonance imaging is preferred.

A minor lid laceration concealing a potentially life-threatening injury

“…Wood can be difficult to detect on plain x-ray films and CT scans as it has a similar density to air and fat and can be interpreted as such 5 6. Therefore, if a wooden foreign body is suspected following a periorbital trauma, an MRI scan is the investigation of choice,5 6 although it should not be used if a metallic foreign body is suspected 3 7.…”

“…Therefore, if a wooden foreign body is suspected following a periorbital trauma, an MRI scan is the investigation of choice,5 6 although it should not be used if a metallic foreign body is suspected 3 7. Lakshmanan et al 5 reported a case of a 10-year-old boy with orbital cellulitis following a lid injury. CT orbit did not show any foreign bodies 5.…”

Lower Lid Entropion Secondary to Missed Intraorbital Foreign Body in a Child

“…This may be due to the inert nature of the foreign body, unlike in cases of intraorbital organic foreign bodies [11] [12]. Interestingly, the kind of injury sustained in this patient, i.e.…”

“…Anaerobic coverage should be provided where the foreign body is suspected to be composed of organic material [12]. Our patient was started on amoxicillin clavulanate for broad spectrum Gram-positive and Gram-negative coverage, and metronidazole for anaerobic coverage.…”

“…Because foreign bodies can cause irritation of the mucosa that can be result in sinusitis [4], the removal of all foreign bodies is generally recommended, even when they do not produce symptoms [14]. In rare cases, the foreign body may extrude spontaneously [12] [15], but in general, the decision of whether to remove an intraorbital foreign body has to be made by the co-managing team.…”