Shoaib Ugradar, Daniel B. Rootman, Mohammed Ali Khan
A teenaged boy presented with a 2-week history of a red left eye and extraocular movement restriction with a history of contact lens wear but denied a history of trauma. His visual acuity was 20/50, and a tender red nodule on the inferotemporal sclera (Fig A) with anterior vitritis were found. Magnetic resonance imaging revealed enhancement of the lateral and inferior recti and adjacent fat (Fig B). An intraocular foreign body (IOFB) embedded in the inferotemporal retina (Fig C) was found on fundoscopy and was later removed following pars plana vitrectomy, resolving the intraocular and orbital inflammation. Final visual acuity was 20/25. Gross examination confirmed the IOFB to be an eyelash (Fig D). (Magnified version of Fig A–D is available online at http://www.aaojournal.org).
Stacy M. Scofield-Kaplan, Elizabeth K. Weidman, Gul Moonis, Lora R. Dagi Glass
Detection of wooden foreign bodies within the orbit can be difficult on imaging, including computed tomography (CT). When visible, wood appears iso- or hypodense and can mimic air or fat. We report the case of a 3-year-old boy with progressive orbital cellulitis following a penetrating wood injury to the right lower lid. CT imaging revealed a linear hyperdensity contiguous with an orbital abscess. He underwent a right anterior orbitotomy with abscess drainage, during which exploration revealed a 2.3 cm retained wooden foreign body. The appearance of wood as hyperdense on imaging is unusual. In the appropriate context, high clinical suspicion for retained wood should be maintained with any irregularity on CT imaging.
Tanie Natung, Wakaru Shullai, Donbok Lynser, Taraprasad Tripathy
A 5 year old boy with a history of fall from a height of about 4 feet, presented after one week with swelling, watering and discharge of the right eye. He had severe conjunctival chemosis with superior displacement of the globe. Computed Tomography (CT) showed a linear low attenuation tract in the right orbit extending from the inferolateral wall up to the left uncinate process of the ethmoid bone with increasing Hounsfield unit after 10 days. The parents did not agree for early exploration. After 10 days an exploration was done and a large linear and irregular wooden foreign body (FB) measuring 4.5 x 1.5 cm2 was removed from the right orbit and a smaller one from the nasal cavity. Four weeks post surgery, his vision was 6/9 in the right eye with the eyeball in the normal position. This case was challenging because of the late presentation, parents not agreeing for early exploration, difficulty in diagnosing by CT and a large and very deep penetrating FB.
Cole, Scott C.; Eftekhari, Kian; Anderson, Richard L.; Oberg, Thomas J.
A 12-year-old boy with a past medical history of nickel allergy was referred to our service after sustaining an air rifle injury with a retained BB in his left inferior orbit. On examination, he had a palpable orbital mass and systemic urticaria. Plain films demonstrated a spherical metallic foreign body adjacent to the left inferior orbital rim. Given his worsening systemic reaction despite oral antihistamine therapy, decision was made to remove the foreign body. In the operating room, the Allergan Magna Finder—a prepackaged, sterile device normally used for retrieval of a port used in tissue expansion surgery—was placed over the inferior conjunctiva of the lower eyelid. With the magnet holding gentle anterior traction on the foreign body, it was easily dissected and removed. The patient tolerated the procedure well, and had rapid resolution of his systemic allergic response following removal of the BB.
Alexander J. Brent, Peter M. Mota, Gerald Saldanha, Ram Vaidhyanath & Raghavan Sampath
A 49-year-old male presented with a 4 month history of dysaesthesia in the left periorbital region. A CT scan showed a lacrimal gland mass with areas of dense calcification. Biopsies of the left lacrimal gland revealed a silver material with associated chronic granulomatous inflammation and secondary calcification. The histological specimen was sent for X-ray microanalysis. This confirmed the silver material to be aluminium. The metal fragments were subsequently discovered to be from a car aerial, which caused an orbital impaling injury 20 years prior to presentation. This is the first reported case of lacrimal gland calcification secondary to chronic metal foreign body exposure. The case is presented alongside literature reviews of lacrimal gland calcification and associated radiological findings.