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Lauren Yeager, Brent Hayek, Joseph Walrath, Sean Blaydon, Russell Neuhaus, Howard Liu, Roman Shinder; Clinical Presentation and Management of Impaled Orbital Foreign Bodies. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1074.
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Transorbital injuries represent up to 24% of penetrating head injuries in adults and 45% in children. There is very little literature describing impaled orbital foreign bodies specifically. We report the presentation, radiography, and treatment outcomes in 6 patients with impaled orbital foreign bodies.
Records of 6 patients evaluated for impaled orbital foreign bodies were reviewed.
Patients (5 male, 1 female) with a median age of 47 years (range 32 - 60) presented to the emergency room after a known history of trauma (4 assaults, 2 accidental). In 6 patients the foreign body was extraconal. The diagnosis in all patients was confirmed by exam and orbital CT (fig 1, 2). All patients were treated with broad spectrum antibiotics and surgical removal of the foreign body via orbitotomy, and one patient required concurrent neurosurgical intervention due to intracranial injury. The globe and optic nerve were spared in all cases, and post injury visual acuity ranged from 20/20 to 20/100. One patient developed fungal infection post injury. At last follow up visit, sequelae included a complete pupil sparing third nerve palsy with ptosis and diplopia in one patient whose superior orbital fissure was involved.
Impaled orbital foreign bodies may be sight threatening and potentially lead to devastating intracranial complications and even death. Although cases may present dramatically, others may be subtle or occult. A thorough exam and CT imaging are indicated in all patients with transorbital injury. Careful surgical removal of the foreign body is the treatment of choice and enlisting a multidisciplinary surgical team may be ideal for best outcomes.
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