Diagnosis and treatment of penetrating orbital cranial foreign body injuries

Abstract

Although periorbital trauma may appear trivial externally, ophthalmic findings of decreased vision, decreased motility, or of any neurological derangement should raise suspicion for more serious injury. In such cases, particularly in children (who may resist revealing the details of the injury), the possibility of a retained foreign body must also be considered. Initial neuroimaging in the form of CT should be carefully reviewed, and concern for a retained foreign body should also be communicated directly to the radiologist, preferably a neuroradiologist. The treating clinician should directly review all imaging studies and not simply rely on written reports. Wooden foreign bodies typically appear as aerated structures and widening of window width and level on CT scans can be helpful in revealing a linear course and overall geometric structure that is highly suspicious for a clinically occult wooden foreign body. If there is any concern for intracranial injury, neurosurgery should be consulted. Special studies, such as CT angiography or formal digital subtraction cerebral angiography, may be warranted to further assess vascular integrity. The foreign body should be extracted as safely as possible, either via anterior orbitotomy or craniotomy taking into account adjunctive measures that may be required to prevent or emergently control potentially life threatening hemorrhage.