Abstract
Background
Sight-threatening complications from retained orbital and intraocular foreign bodies
are frequently reported in literature. Delays in diagnosis can result in severe complications,
including choroidal neovascularization, infection, and irreversible vision loss. Therefore,
it is imperative that emergency physicians consider the possibility of orbital and
intraocular foreign bodies when evaluating patients with acute facial trauma.
Case Report
A 91-year-old woman with a history of laser-treated glaucoma and cataracts presented
to an outside emergency department after a ground-level fall. A maxillofacial noncontrast
computed tomography scan showed no facial fractures or hemorrhage, but a 41 mm × 4
mm foreign body within the intraconal compartment of the right orbit was identified.
The object was presumed to be an implanted glaucoma drainage device, and the patient
was discharged without antibiotics. One day after discharge, the patient developed
right periorbital swelling and erythema with increasing purulent discharge and skin
thickening, ultimately requiring transfer to our facility for management of complex
right orbital cellulitis, orbital compartment syndrome, and surgical foreign body
removal. Despite globe exploration and surgical intervention, the patient developed
a frozen globe with no light perception in the right eye.
Why Should an Emergency Physician Be Aware of This? Subtle ophthalmologic emergencies such as sight-threatening foreign bodies can be
challenging to diagnose on imaging, particularly with the advent of implantable ocular
technology. When an orbital foreign body is discovered in the context of facial trauma,
early ophthalmology consultation should be considered.
Keywords
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Article info
Publication history
Published online: May 02, 2022
Accepted:
April 23,
2022
Received in revised form:
April 7,
2022
Received:
February 2,
2022
Identification
Copyright
© 2022 Published by Elsevier Inc.
