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Abstract
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Penetrating injury into the orbit from a foreign body is rare.1 We present a case of penetrating orbital injury due to a wooden cake dowel. We aim to raise awareness to avert potentially devastating ocular or orbital injury, which fortunately was avoided in this patient.
A 14-year-old girl presented with left upper eyelid swelling and pain following periocular trauma. At her birthday celebration earlier that day, her face was shoved from behind into a multilayered cake with a wooden dowel that punctured through her left upper eyelid (Figure 1). The wooden dowel tip broke, leaving a small remnant in her eyelid that was removed by a family member at the scene. Her examination demonstrated left upper eyelid ecchymosis and edema with a stellate medial entrance wound filled with pigmented cake material and pale soft tissue (Figure 2A). There was no evidence of penetrating globe injury. Orbital computed tomography showed a left upper eyelid hematoma without orbital fractures, intracranial injury, deformed globe, or radiopaque foreign body. A small hypodensity was present lateral to the left globe and interpreted as air or foreign body (Figure 2B and C). Orbital magnetic resonance imaging was limited by field distortion. The inconclusive imaging coupled with the splintered wooden dowel (Figure 1C), suggesting wooden fragments may remain in the orbit, prompted surgical exploration. The wound and penetrating orbital tract were explored and found to extend posteriorly in a beveled fashion through the orbicularis and septum. Gold cake pigment was noted, but there was no tarsal fracture, levator aponeurosis transection, or wooden dowel remnant, suggesting the radiographic hypodensity was air. The tract was irrigated with gentamycin, and the wound was debrided and closed. The patient received perioperative ceftriaxone as well as postoperative antibiotic ointment and a methylprednisolone tapered dose pack. At 1-month follow-up, she had no pain, evidence of infection, or motility disturbance...
Language: en |