Treatment of an Uncommon High-Pressure Orbital Injection Injury

Abstract

Injection injuries occur most commonly in the hand and digits; however, there are a limited number of reports in the literature describing injection injuries involving the orbit. High-pressure orbital injection injuries pose a number of unique challenges to the treating physician, and the approach to treating these injuries remains controversial. Often times, the extent of tissue damage is not fully appreciated at presentation, which may lead to missed diagnoses or inadequate initial treatment. In this study, the authors describe a rare incidence of high-pressure orbital injection injury. A 19-year-old male presented to the emergency department after injection of his left orbit with oil-based paint. Worsening clinical symptoms and increasing intraocular pressures within the first 24 hours necessitated take back to the operating room for orbital decompression and debridement. After an initial improvement in symptoms, the patient's clinical status deteriorated again, requiring further orbital decompression and additional periorbital debridement. Two weeks after initial presentation, soft tissue reconstruction of the surgical wounds was performed with full thickness skin grafts. The patient's globe and vision were both preserved. Orbital injection injuries, though rare, are potential globe threatening injuries. Physicians should have a low threshold for intervention and patient's must be observed closely over the first 72 hours after injury. Early diagnosis, prompt debridement, and a multidisciplinary approach are keys to improving patient outcomes.

Orbital and intracranial Nocardia farcinica infection caused by trauma to the orbit: a case report

“…Clinical manifestations of orbital infection usually involve periorbital edema, crepitus, ophthalmoplegia, exophthalmos, chemosis, and visual loss [2, 7]. The case we have reported here had no other specific features, and the symptoms mentioned above are similar to those for subacute local infection.…”

“…The patient in this case had no obvious immunodeficiency and was infected due to traumatic orbital injury. Infection by direct orbital injury is rare, as most injury-mediated infections occur in the limbs and skin [2]. According to Torres et al, a literature review of nocardiosis showed that traumatic injuries accounted for only 10% of infections [1].…”

“…Nocardia farcinica infection is rare and often occurs in immunocompromised patients and is especially attributable to the respiratory tract or traumatic wounds [1]. N. farcinica infection caused by injuries occurs most commonly in the limbs and skin [2]. Orbital infection due to orbital trauma is uncommon.…”

Successful control of scleritis caused by Nocardia farcinica: A case report

“…[ 11 , 12 ] Once the infection occurs, the onset of disease is acute, but the development is rapid with strong invasiveness, severe tissue destruction and long course of treatment. [ 13 ] The patient in this study is a decoration worker. Because foreign bodies (e.g., soil) often collapsed into the eye, and the left cornea had punctate foreign body residues, it is suspected that the patient had infectious scleritis involving the corneal limbus caused by N. farcinica from the trauma wound.…”