A Curious Case of Foreign Body Orbit

Introduction

A foreign body may be any object in an area where it is not meant to be and can cause harm by its presence if medical attention is not sought.^1,2 Foreign bodies in the ears, nose, or throat are a common occurrence in Ear, Nose, Throat (ENT) emergency services, however, they are very rare in the infratemporal fossa.³ High-velocity traumas can lead to penetrating injury of the orbit which can lead to foreign body lodgement in many areas like the paranasal sinuses, nasal cavity, brain, infratemporal fossa, or pterygopalatine fossa.

Case Presentation

A 35-year–old male, with no known comorbidities, presented with a retained foreign body in the right eye following an accidental trauma while opening a wooden door (Figure 1).

On examination, a penetrating wooden stick was seen protruding from below the right lower eyelid of the patient. The patient was conscious, oriented, and hemodynamically stable. The patient did not complain of any watery nasal discharge, nasal obstruction, or diplopia. There was no evidence of active bleeding or restriction of extraocular movements. The vision was found to be normal in both eyes without any chemosis or conjunctival congestion. The right upper and lower eyelids were edematous.

A Computed Tomography (CT) scan was taken to evaluate the depth of penetration of the foreign body, which showed a hypodense linear foreign body of length 4.3 cm in the inferior aspect of the right orbit, posteriorly piercing the postero-lateral wall of the orbit, entering into the infratemporal fossa. Globe was found to be intact (Figure 2).

The patient was hospitalized and started on high-dose antibiotics, analgesics, and anti-tetanus prophylaxis. The patient was posted for emergency operation theatre (OT) for foreign body removal. The entry wound was dissected in layers and the foreign body was adequately mobilized. It was then removed manually, by giving adequate traction. The tract was explored and complete removal of the foreign body was ensured. Hemostasis was achieved and the wound was allowed to heal by secondary intention.

The patient was followed up after 1 month and vision was found to be normal with a completely healed external scar. The foreign body’s size in comparison to a 3 mL syringe is depicted in Figure 3.

Discussion

Cases of foreign bodies invasion are estimated to be 11%⁴ of the total cases seen in ENT services with the most common location being the ears.² Around 54.69% of such foreign bodies are removed under general anesthesia.⁵ Infratemporal fossa foreign bodies present with swelling in the zygomaticomaxillary region, otalgia, and trismus.⁶ Its migration can cause vision loss and other intracranial complications. Neglected foreign bodies can lie dormant for a long time and later cause complications. A CT scan is useful in knowing the size and extent of penetration of the foreign body. An Magnetic resonance imaging (MRI) scan may be used in cases of the wooden intra-orbital foreign body for better differentiation with fat or air.⁷ Hounsfield units of wooden foreign bodies are shown to increase over time.⁸ Wooden foreign bodies can serve as a good bacterial culture medium and therefore, it is very important to remove them immediately and completely.⁹

Conclusion

Timely management of ENT foreign bodies is important to prevent morbidity and mortality. Recognition of foreign body lodgement in the infratemporal fossa is important to prevent life-threatening complications due to its proximity to many vital structures. Removal of such a foreign body may require multiple imaging modalities and a specialist team with a good knowledge of anatomy.

Conflict of interest

None