An Unexpected Intraorbital Foreign Body Benjamin P. Erickson, M.D., Yasha S. Modi, M.D., Basil Williams, M.D., and Sophie D. Liao, M.D. Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, U.S.A.
FIG. 1. (A) Clinical appearance of the patient, demonstrating a previously sutured laceration of the right upper eyelid. Computed tomography (CT) scan with axial (B) and coronal (C) views of an occult foreign body in the superonasal orbit.
52-year-old male with unknown medical and ocular history was assaulted while intoxicated. The mechanism of injury could not be further elucidated, given limited patient cooperation and the absence of witnesses. Bedside examination disclosed 20/200 and 20/70 uncorrected near vision in the right and left eyes. Intraocular pressures were 32 and 12 mm Hg, respectively. Pupils were round and reactive bilaterally without a related afferent pupillary defect. External examination revealed extensive periorbital edema and ecchymosis with complete ptosis (Fig. 1A). An upper eyelid laceration had been sutured prior to ophthalmologic consultation.
Accepted for publication December 9, 2014. The authors have no financial or conflict of interest to disclose. Address correspondence and reprint requests to Benjamin P. Erickson, M.D., Bascom Palmer Eye Institute, 900 NW 17th Street, Miami, FL 33136. E-mail: [email protected]
FIG. 2. (A) Intraoperative photo demonstrating foreign body removal via the opened laceration. (B) The foreign body is revealed as the cap of a Bic Matic™ mechanical pencil.
Complete restriction to abduction, elevation, and depression (−4), with mildly diminished adduction (−1), was present in the right eye. Anterior and posterior segment examination was notable only for subconjunctival hemorrhage and mild cataracts. Subsequent CT of the orbits (Fig. 1B,C) demonstrated right-sided proptosis with periorbital and retrobulbar hematoma, an oblong 2.3 × 0.5 cm foreign body, and a displaced nasal fracture. No violation of the cribriform plate or intracranial extension were identified radiographically. Intraoperative exploration through the previously sutured laceration revealed the end of a hollow plastic shaft within the superonasal orbit (Fig. 2A). This foreign body abutted, but did not penetrate, the globe and trochlea complex. Close examination identified the foreign object as the cap of a Bic Matic™ mechanical pencil (Fig. 2B). One month postoperatively, visual acuity was 20/30 bilaterally, with normalization of intraocular pressure and motility. This case highlights the need for careful exploration of all periocular wounds with an unknown mechanism of injury. Ophthal Plast Reconstr Surg, Vol. 31, No. 5, 2015
Copyright © 2015 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc. Unauthorized reproduction of this article is prohibited.