DEEP PENETRATING INJURY OF THE ORBIT WITH RETAINED FOREIGN BODY

Orbital porencephalic cyst following penetrating orbitocranial trauma

In a 10-year-old boy an orbitocranial penetrating wound produced by an umbrella tip caused an orbital roof bone fragment to penetrate up to the anterior part of the third ventricle behind the left foramen of Monro. Hemorrhages and encephalomalacia developed along the trajectory of the fragment and subsequently a porencephalic cyst was formed at this site. Six months after the trauma, increased pressure developed in the left ventricular system due to obstructive hydrocephalus and consequently the porencephalic cyst herniated into the orbit through the orbital roof fracture, producing intermittent diplopia, left exophthalmos, and palpebral swelling. A ventriculo-peritoneal shunt led to shrinkage of the orbital cyst content and resolution of the symptoms.

Posterior penetrating injury of the orbit with retained foreign body

A case of a retained orbital foreign body following a penetrating injury in a 2-year-old boy is described. Diagnosis and management of such cases is discussed.

Foreign bodies in the orbit. Review of 20 cases

The interdisciplinary problem of foreign bodies in the orbit is presented on the basis of personal experience in the treatment of 20 patients. These foreign bodies often cause severe injuries to the organ of sight and even threaten life. Early removal of a foreign body is technically easy, prevents infection and facilitates anatomical reconstruction of the damaged structures. Only in exceptional cases may removal be avoided. Of the 20 patients treated, only 9 were early admissions to our Department where the foreign body was removed and primary surgery performed. The others were admitted after some delay, which made correct treatment more difficult. Data on the injuries found in 20 patients, surgical technique, follow up and results are presented. Total recovery was obtained in 7 patients, improvement in vision in 2, enucleation of the globe was necessary in 5, and in 2 loss of vision was a sequel to a lesion of the optic nerve. Depending on the indications, reconstructive plastic surgery and prosthetic rehabilitation gave good aesthetic results. The necessity for interdisciplinary collaboration in the diagnosis and treatment of patients with foreign bodies in the orbit is emphasized.

Ocular injuries caused by airgun pellets: an analysis of 105 cases

One hundred and five cases of airgun pellet injuries of the eye have been analysed. The average age was 14 and the male to female ratio 7.5:1. Forty-five patients had final visual acuities of 6/18 or less in the injured eye and 19 of these had the eye removed. The two main causes for poor vision were retinal damage and cataract. One patient became completely blind after sympathetic ophthalmitis arising 11 years after the injury. The pellet lodged in the orbit in 14 cases and three of these, together with one who had an intraethmoidal pellet, were investigated for abnormal lead levels in blood and urine. The results were normal.The circumstances of the injury were obtained in 12 cases and most involved careless handling of a gun. Instruction of children and parents in schools and on television, rather than stricter legislation, is suggested as a means of prevention.