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Penetrating orbit injury: challenge to emergency medicine.

Malla G, Bhandari R, Gupta PP, Giri R - BMC Res Notes (2013)

Bottom Line: The case discussion will review the initial presentation, examination, resultant management decisions, and final outcome.Resource availability and conditions at presentations may also influence the management decisions.This case presentation has described such a scenario in developing country like Nepal and is expected to be interest across various medical specialties.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Practice and Emergency Medicine, B,P,Koirala Institute of Health Sciences Dharan-18, Dharan, Nepal. dr.pramen@gmail.com.

ABSTRACT

Background: Penetrating orbital injuries pose a serious threat to vision, ocular motility, and in some cases, life. The setting and causes of eye injury are diverse, but previous studies have demonstrated that the risk and type of injury is often correlated with age, gender, and race. Pediatric ocular injury is often accidental and may be preventable. A focused history and prompt ocular examination are essential to immediate management.

Case presentation: This article describes a case of protruding foreign body-related penetrating orbit injury with a retained foreign body in a 4-year-old male from a town in the eastern part of Nepal. The child presented to the emergency with foreign body in situ without receiving any pre emergency care without any medical attendance. The patient was managed with non-operative removal of foreign body in the emergency. The case discussion will review the initial presentation, examination, resultant management decisions, and final outcome.

Conclusion: Foreign body presentations may be diverse and non-operative management may be considered in selected cases. Resource availability and conditions at presentations may also influence the management decisions. This case presentation has described such a scenario in developing country like Nepal and is expected to be interest across various medical specialties.

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Related in: MedlinePlus

Showing insertion of foreign body.
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Figure 3: Showing insertion of foreign body.

Mentions: Intravenous access was established. Pain was managed with morphine and prophylactic antibiotics were initiated. CT scan was arranged. Patient was sedated with ketamine and midazolam. The patient was transferred to CT scan with the relative supporting the foreign body all the time. The contrast CT was initially reported by a radiology resident as follows, “foreign body lateralizing globe and penetrating through the medial part of the orbit extending through orbital apex to middle cerebral fossa and just impinging right cerebellar hemisphere. Minor contusions in right cerebellum and hemi sinus ethmoidal sinus are suspected. The length of the penetrating part was around 9 cm” (Figure 3). Upon immediate ophthalmology consultation, a decision to remove the foreign body was made. Again, anesthetists were unavailable for timely removal of the foreign body as they were busy in theatre. Due to the time delays pre presentation, it was decided that removal of the foreign body should occur as quickly as possible. The ophthalmologist and the emergency physician removed the foreign body, with the aid of sedation (ketamine, morphine and thiopentone). A lateral canthotomy was performed (Figure 4).


Penetrating orbit injury: challenge to emergency medicine.

Malla G, Bhandari R, Gupta PP, Giri R - BMC Res Notes (2013)

Showing insertion of foreign body.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4222094&req=5

Figure 3: Showing insertion of foreign body.
Mentions: Intravenous access was established. Pain was managed with morphine and prophylactic antibiotics were initiated. CT scan was arranged. Patient was sedated with ketamine and midazolam. The patient was transferred to CT scan with the relative supporting the foreign body all the time. The contrast CT was initially reported by a radiology resident as follows, “foreign body lateralizing globe and penetrating through the medial part of the orbit extending through orbital apex to middle cerebral fossa and just impinging right cerebellar hemisphere. Minor contusions in right cerebellum and hemi sinus ethmoidal sinus are suspected. The length of the penetrating part was around 9 cm” (Figure 3). Upon immediate ophthalmology consultation, a decision to remove the foreign body was made. Again, anesthetists were unavailable for timely removal of the foreign body as they were busy in theatre. Due to the time delays pre presentation, it was decided that removal of the foreign body should occur as quickly as possible. The ophthalmologist and the emergency physician removed the foreign body, with the aid of sedation (ketamine, morphine and thiopentone). A lateral canthotomy was performed (Figure 4).

Bottom Line: The case discussion will review the initial presentation, examination, resultant management decisions, and final outcome.Resource availability and conditions at presentations may also influence the management decisions.This case presentation has described such a scenario in developing country like Nepal and is expected to be interest across various medical specialties.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Practice and Emergency Medicine, B,P,Koirala Institute of Health Sciences Dharan-18, Dharan, Nepal. dr.pramen@gmail.com.

ABSTRACT

Background: Penetrating orbital injuries pose a serious threat to vision, ocular motility, and in some cases, life. The setting and causes of eye injury are diverse, but previous studies have demonstrated that the risk and type of injury is often correlated with age, gender, and race. Pediatric ocular injury is often accidental and may be preventable. A focused history and prompt ocular examination are essential to immediate management.

Case presentation: This article describes a case of protruding foreign body-related penetrating orbit injury with a retained foreign body in a 4-year-old male from a town in the eastern part of Nepal. The child presented to the emergency with foreign body in situ without receiving any pre emergency care without any medical attendance. The patient was managed with non-operative removal of foreign body in the emergency. The case discussion will review the initial presentation, examination, resultant management decisions, and final outcome.

Conclusion: Foreign body presentations may be diverse and non-operative management may be considered in selected cases. Resource availability and conditions at presentations may also influence the management decisions. This case presentation has described such a scenario in developing country like Nepal and is expected to be interest across various medical specialties.

Show MeSH
Related in: MedlinePlus