Intraorbital foreign bodies

The site of entry of an orbital foreign body may be self-sealing and easily overlooked. Highspeed foreign bodies are more likely to penetrate the globe, whereas low-speed ones (such as twigs) are more likely to spare the globe. Failure to remove an unsterile foreign body is likely to result in an intraorbital or intracranial abscess, or an externally draining sinus (Figure 14.8).

The prime investigation for localisation is thin-slice axial and direct coronal CT scan (Figure 14.9) and MRI should be considered -but only after excluding the presence of intraorbital ferro-magnetic materials - where wood and other materials of vegetable origin are thought to be present.

Treatment

Removal of an orbital foreign body is indicated when there is thought to be

(a)

Figure 14.8 Wooden foreign body in the inferior part of the orbit and the pterygopalatine fossa: (a) coronal and (b) axial view.

Figure 14.8 Wooden foreign body in the inferior part of the orbit and the pterygopalatine fossa: (a) coronal and (b) axial view.

reversible visual impairment, persistent pain, diplopia, inflammation or infection, or when the object is palpable in the anterior part of the orbit. Unless the foreign body is visible under the conjunctiva, surgery should be under general anaesthesia as location of the materials can be difficult. When a foreign body is inert and posterior within the orbit (Figure 14.10), it can be left in place and the risk of surgical damage to the orbital contents avoided.

All organic matter must be removed, as this typically incites a vigorous inflammatory response and is liable to infection. Non-metallic inorganic materials, such as glass, stone or plastics, may generally be left and observed and non-reactive metals, such as stainless steel, steel or aluminium, are well tolerated. Copper-containing metals, including

Figure 14.9 Inferior orbital foreign body with associated brain abscess.
Figure 14.10 Airgun pellet deep within orbit, thus not requiring removal.

brass, should be removed as they cause marked suppurative inflammation. Intraorbital lead can be left, as it does not appear to cause systemic toxicity and intraorbital iron does not have the toxicity of intraocular iron.

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