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Tuesday, September 16, 2014

7 cm pencil stuck in eye orbit


Every once in a while, children tend to get a bit wild while playing. Unfortunately, sometimes just one moment of carelessness can have severe consequences. Even something as banal as tripping and falling can result in a serious injury, as this case from Iran shows. 


In 2011, a 6-year-old boy with orbital trauma was brought to the the Ophthalmology Department of Imam Khomeini Hospital in Kermanshah. According to his parents, he suddenly fell when playing and landed on a pencil, which penetrated the upper part of his right orbit and split, so that half of it remained lodged above the eye. Because the pencil had broken at the entry point, it could not be removed manually. The situation was quite grim, since the penetration of objects into the orbit can lead to blindness and even to the death of the patient as a result of brain damage and/or infection.



 A broken piece of pencil sticking out from the upper cavity of the right orbit. Ouch!


A physical examination with a slit lamp biomicroscope showed no damage to the boy’s cornea. The conjunctiva was lacerated, with sub-conjunctival hemorrhage, and the eyeball itself was severely hypertonic and tense. Since the child was in great pain and severely agitated, doctors were unable to perform a CT scan. However, an X-ray showed a straight object, clearly looking like a pencil, stuck in the orbital space.



An X-ray shows a long object in the orbital space, behind the eye. You can see that the object's outer shell is less dense (dark) as compared to the core. X-rays pass easily through wood, but not through carbon.


The child was rushed to the operation room to try to save his eye. After general anesthesia, the pencil was carefully removed from the orbit. It turned out to be a whopping 7 centimeters long! By comparing the two broken sections of the pencil, the surgeon could confirm that nothing was left behind, but to be absolutely sure, a CT scan was performed. It showed the complete removal of the foreign object from the orbit and no damage to the patient's eye or brain. (The boy's parents must have breathed a huge sigh of relief at this point.)



The bloodstained piece of pencil - 7 centimeters long - after removal.
(All images from: Rezae et al. 2014)

The boy was supervised for two months after surgery and showed no adverse effects from the trauma. Notably, his eyesight did not suffer as a result of this accident - his visual acuity was still 10/10. He's one lucky child, since he could have very easily lost his eye.


Source:

Rezae L, Naiafi F, Moradinazar M, Ahmadijouvbari T. (2014) Case report on the successful removal of an organic penetrating object into the orbit. J Inj Violence Res. 6(1): 50–52.

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