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Year : 2000  |  Volume : 10  |  Issue : 1  |  Page : 29-30
Case report: CT detection of an unusual intra-orbital foreign body


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Keywords: Intra-orbital, foreign body, CT

How to cite this article:
Shyamkumar N K, Davd S, Raju R, korah I P. Case report: CT detection of an unusual intra-orbital foreign body. Indian J Radiol Imaging 2000;10:29-30

How to cite this URL:
Shyamkumar N K, Davd S, Raju R, korah I P. Case report: CT detection of an unusual intra-orbital foreign body. Indian J Radiol Imaging [serial online] 2000 [cited 2019 Sep 20];10:29-30. Available from: http://www.ijri.org/text.asp?2000/10/1/29/30628
Penetrating injury to the orbit is a common presentation to the ophthalmology outpatient department. An orbital foreign body may be overlooked because a small penetrating wound may be accompanied by minimal or no signs of inflammation early in the clinical course [1]. CT plays a major role in the localization of such foreign bodies. We would like to report the case of an unusual intra-orbital foreign body. Its presence was not suspected on initial clinical examination and it was not visualized on US, but it was subsequently detected on CT.


   Case Report Top


A 40-years old man presented with a penetrating injury to the medial aspect of left orbit. On examination, visual acuity was 20/20 in both eyes. A small laceration at the superomedial aspect of the left orbit was seen, which was explored and sutured.

Three days later, the patient returned with pain, chemosis and proptosis of left eye. Plain radiographs of the orbits and US examination did not show any pathology. CT of the orbits in the coronal [Figure - 1] and axial [Figure - 2] planes revealed a well-defined tubular structure between the optic nerve and medial rectus muscle. It was closely related to the outer margin of the wall of the globe and had no intraocular component. The posterior end of the object was tapering and directed towards the orbital apex. It measured 25mm in length, 8mm in outer diameter and 2mm in thickness. A small air pocket was noted in the posterior orbit. The normal hypodensity of the orbital fat was lost, indicating edema.

The patient underwent surgery for removal of the foreign body. The tip of a plastic ballpoint pen [Figure - 3] was removed. The adjacent tissue was inflamed. The foreign body and the inflammatory changes were identical to the findings on the CT images. The postoperative period was uneventful. The patient was normal on one-year follow up.


   Discussion Top


The presence of a foreign body was not suspected initially due to inadequate history and paucity of clinical findings. An object that penetrates through the orbit may leave only a small entry wound. These patients may have normal vision, a normal neurological examination and normal plain radiographs, despite trauma that may lead to significant complications [2].

A CT of the orbit was performed when the patient came back with new symptoms and the plain radiographs taken did not show any radio-opaque foreign body. The CT showed the presence and exact location of the foreign body.

Non-visualization of a foreign body on US may be because the foreign body is isoechoic to orbital fat or because of other factors such as a smooth surface or a posterior location in the orbit.

The incidence of intra-orbital foreign bodies in orbital trauma was found to be 2.9% in a series of 677 patients [3]. Intra-orbital foreign bodies usually result from occupational accidents, gunshot injuries and road traffic accidents. Self inflicted injuries have also been reported [4]. Most of the foreign bodies are metallic, wooden particles or glass pieces.

Accurate localization of foreign bodies in the region of the orbit is vital for correct management [5]. CT is the investigation of choice. Both axial and direct coronal views are preferred with 3mm sections proving sufficient for most orbital injuries [6].

Though it is not necessary to surgically remove inert extraocular foreign bodies, in our case, surgical removal was performed considering the risk of infection.

In an age when plastics are used in most day to day objects and are largely replacing metal and glass, it must be remembered that plastic is not particularly radio-opaque and can be missed on plain radiographs. The superior sensitivity of CT for detecting small variations in X-ray absorption allows easy and accurate detection of such foreign bodies.

 
   References Top

1.Bullock JD, Warwwar RE, Bastley GB, Waller RR, Henderson JW. Unusual orbital foreign bodies. Ophthal Plast Constru Surg 1999; 15: 44-51.  Back to cited text no. 1    
2.Wesley RE anderson SR, Weiss PIR, Smith HP. Management of orbital cranial trauma. Adv. Opthal Plastic Reconstruct. Surgery 1987; 7: 3-26.  Back to cited text no. 2    
3.Barkowski S, Kurek, M, Stypulkdisa, J. Krystkowa KM and Zapala, J. Foreign bodies in the orbit Review of 20 cases. Journal of Maxillo-facial surgery 1984;12: 97-102.  Back to cited text no. 3    
4.Green KA, Dickman CA, Smith KA, Kinder EJ, Zabramski, JM. Self-inflicted orbital and intracranial injury with a retained foreign body, associated with psychotic depression: case report and review. Surg Neurol Dec1993; 40: 499-503.  Back to cited text no. 4    
5.Etherington R.J. Houriham M.D.Localistaion of intraoccular and intraorbital foreign bodies using computed tomography. Clinical Radiology 1989; 40: 610-614.  Back to cited text no. 5    
6.Peter AD Rubin Jurij R Bilyk John Wshore.Management of orbital trauma: Fractures, hemorrhage and traumatic optic neuropathy. Focal points. Sept 1994; 12: 1-17.  Back to cited text no. 6    

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Correspondence Address:
N K Shyamkumar
India

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    Figures

[Figure - 1], [Figure - 2], [Figure - 3]

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