Pigmented Orbital Mass Due to Remote Pencil Trauma

Lee, Brian J.; Gupta, Shivani; Flint, Andrew; Singer, Thomas; Elner, Victor M.

doi:10.1097/iop.0b013e3182271ac5

Cited by 7 publications

(6 citation statements)

References 6 publications

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“…The pigmented nature of the lesion was important in this case because of the concern for melanoma, as has been noted in previous cases [2,5]. CT imaging may be considered to evaluate the extent and character of pigmented lesions in the eyelid or anterior orbit.…”

Section: Discussionmentioning

confidence: 95%

“…There appears to be a trend of remote pencil trauma only being revealed after surgical intervention [2,5]. Clinicians may want to consider graphite granuloma when they see a pigmented mass in the eyelid or anterior orbit.…”

Section: Discussionmentioning

confidence: 99%

“…Pencil injuries to the eye and adnexal tissues have variable presentations within the few reported cases [1,2,3,4,5,6]. In the skin, pencil “lead” injuries may present anytime between 1.5 and 58 years after implantation of the core [7,8,9].…”

Section: Introductionmentioning

confidence: 99%

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Enlarging Pigmented Eyelid Mass Associated with Remote Pencil Trauma

Phelps¹,

Carlson

Meyer

2017

Ocul Oncol Pathol

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The authors present a case of a gradually enlarging pigmented mass of the upper eyelid and anterior orbit that was discovered to be the graphite tip of a pencil surrounded by macrophages bearing graphite and fibrous tissue. A 25-year-old woman with no medical history presented with a gradually enlarging pigmented lesion of her left upper eyelid. She denied any history of previous skin cancer, trauma, or previous surgery. A biopsy was performed. This revealed an encapsulated grayish, pigmented mass within the medial portion of the left upper eyelid and anterior orbit. Within the pigmented cocoon, the graphite core of a pencil (“pencil lead”) was identified. Histopathology demonstrated granulomatous inflammation with fibrosis and macrophages.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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Enlarging Pigmented Eyelid Mass Associated with Remote Pencil Trauma

Phelps¹,

Carlson

Meyer

2017

Ocul Oncol Pathol

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“…These conditions make diagnosis difficult and inaccurate, leading to a delay in further treatment [19] . Besides, nonspecific symptoms of penetrating traumas, including vision changes, ophthalmoplegia, ptosis, tearing, drowsiness, fever, vomiting, and seizures, also bring the challenge to the timely and accurate diagnosis [20][21] . As Imaging examinations are of great significance for the diagnosis of IOFBs.…”

Section: Discussionmentioning

confidence: 99%

Clinical features, radiological imaging, and treatment strategies of nonmetallic intraorbital foreign bodies: a retrospective analysis

Chai¹,

Song²,

Lü³

2023

Int J Ophthalmol

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AIM: To provide comprehensive data on nonmetallic intraorbital foreign bodies (IOFBs) by summarizing and analyzing material types, clinical manifestations, imaging features, and treatment strategies. METHODS: Totally 28 nonmetallic IOFB cases treated at Shengjing Hospital of China Medical University from 2012 to 2020 were retrospectively reviewed. The types of foreign bodies, clinical features, imaging manifestations, and treatment outcomes were analyzed. RESULTS: Among all cases, 67.8% (19/28) of the foreign bodies were organic. The top three entrances were the upper eyelid skin (7/28), lower fornix conjunctiva (6/28), and lower eyelid skin (4/28). In most cases (11/28, 39.3%), foreign bodies remained in the medial orbits. The major clinical manifestations included eyelid redness and swelling (20/28, 71.4%), conjunctival congestion and edema (17/28, 60.7%), and ophthalmoptosis (15/28, 53.6%). Infection was the main complication, which occurred in 57.1% (16/28) of all cases. Computerized tomography (CT) values differed for different foreign bodies and varied in the different periods after injury. The plant- and grease-derived foreign bodies and the surrounding pus cysts showed different signals on magnetic resonance imaging (MRI). The prognosis varied with different foreign body types, surgery timing, and intraoperative management. CONCLUSION: The majority of nonmetallic IOFBs are organic and often remain in the superior, medial, and inferior areas of the orbit. Clinical manifestations vary owing to their different textures. CT and MRI facilitate the identification of foreign body materials. Plant-derived foreign bodies should be completely removed, and surgical treatment is a complicated process.

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“…1 Retained graphite pencil lead can lead to delayed granulomatous reaction from several weeks to several decades postinjury. 2,3,4 Because of differences in composition, colored pencil core may behave differently than graphite pencil core within tissues. Colored pencil core does not typically contain graphite and is often composed of pigment, resins, and binders such as talc, paraffin, clay, metallic powders, and additives.…”

Section: Discussionmentioning

confidence: 99%

A Case of the Blues—Colored Pencil Orbitopathy in an 18-Month-Old Boy

Hwang

Maltry

Harrison

et al. 2022

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Orbital penetrating injuries from pencils are rare. This report describes a case of penetrating orbital injury in a young child with a retained blue-colored pencil core foreign body, which led to rapid onset of orbital abscess requiring surgical drainage. Intraoperatively, orbital tissues were stained a bright-blue color. Histopathological study of specimen also highlighted bright blue aggregates of foreign material infiltrating the orbital tissues. Cultures grew Streptococcus mitis and Exophiala jeanselmei, which are rare causes of orbital abscess. Unique properties of retained colored pencil core as compared to graphite pencil core are herein discussed. Due to differences in composition, colored pencil core foreign bodies may require more timely surgical intervention compared to noncolored graphite pencil core.

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Pigmented Orbital Mass Due to Remote Pencil Trauma

Cited by 7 publications

References 6 publications

Enlarging Pigmented Eyelid Mass Associated with Remote Pencil Trauma

Enlarging Pigmented Eyelid Mass Associated with Remote Pencil Trauma

Clinical features, radiological imaging, and treatment strategies of nonmetallic intraorbital foreign bodies: a retrospective analysis

A Case of the Blues—Colored Pencil Orbitopathy in an 18-Month-Old Boy

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