Body Intraorbital



Intraorbital foreign bodies (IOFBs) occur as a result of a high-velocity penetrating injury or direct impalement of an object.


The majority are male, typically of young age (less than 30 years old).


Education and protective eyewear.


Traumatic insertion of a foreign body through the eyelid or conjunctiva.


• Projectile, usually metallic, foreign bodies such as BB pellets and firearms

• Penetrating trauma from nonmetallic foreign bodies, either organic (e.g., tree branch, pencil) or inorganic (glass, plastic, or stone)



• A history of periocular trauma is usually elicited.

• A delayed presentation from the time of injury is not uncommon, especially with children or patients who sustain trauma while under the influence of various substances.

• A detailed history is essential in patients who present with orbital infections or inflammation.


• Visual acuity can range from normal to complete loss of vision, depending on associated ocular and orbital injuries.

• Afferent papillary defect may be present if optic nerve is involved.

• Extraocular muscle underaction, if extraocular muscles are affected

• Gaze-evoked amaurosis (with apical IOFBs)

• Blepharoptosis

• Proptosis

• Orbital inflammation

• Careful examination of the periocular skin and conjunctiva, especially the fornices, to identify entry wound



• Wound culture (aerobic, anaerobic, fungal)

• Foreign body culture

• CBC may reveal elevated serum white cell count secondary to chronic orbital inflammation


• Plain film radiographs for metallic IOFBs

• CT

– Excellent for identifying metal or glass

– Safe in the presence of ferromagnetic metallic foreign bodies

– Inorganic IOFBs (e.g., wood) can mimic air on CT

– Quantitative CT with wide bone window settings can distinguish wood from low-density signals of air or fat

• MRI if CT scan is negative and non-metallic IOFB is suspected

– MRI can be used to localize BB pellets, which are made of steel, and coated with copper or zinc

• Ultrasound (US) can be used to localize the IOFB; however it does not image the orbital apex reliably.

Follow-up & special considerations

• Orbitocranial extension should be ruled out, especially in children who have thinner orbital bones.

– Coronal and parasagittal images should be obtained in suspected transorbital, intracranial penetration.

Diagnostic Procedures/Other

Electroretinography (ERG) to assess for photoreceptor toxicity if iron or copper containing IOFB is adjacent to sclera.

Pathological Findings

With organic IOFBs: Chronic inflammation with or without granulomatous reaction and fibrosis.


• Orbital cellulitis

• Idiopathic orbital inflammation

• Orbital neoplasm (children)



• Broad-spectrum antibiotic therapy with anaerobic coverage, in cases of orbital cellulitis secondary to chronically retained IOFBs (more common with organic IOFBs)

• Antitetanus prophylaxis


• Surgical removal depends on visual status, composition of IOFB, and location within the orbit.

• Surgical removal is indicated for the following:

– Neurological compromise

– Ocular motility restriction

– All organic IOFBs

– Inorganic IOFBs if they are located in the anterior orbit and are easily accessible

• Inorganic IOFBs that are located posteriorly may be left in place, unless they are causing orbital complications.

• Percutaneous US and fluoroscopy can be used intraoperatively to localize the IOFB.



• Ophthalmologist

• Neurosurgeon (if intracranial involvement)


• Vision loss is generally related to initial injury and not as a result of complications from IOFB or management.

• Retained metallic IOFBs are usually well-tolerated and have a good visual prognosis. The exception is metallic IOFBs containing copper, which can cause a chronic suppurative orbital inflammation.

• Organic IOFBs have a higher incidence of vision-threatening complications, and a higher risk of orbital and cerebral infections.


• Acute orbital cellulitis (usually from organic material such as wood)

• Chronic suppurative orbital inflammation (from copper foreign bodies)

• Sterile abscess

• Orbitocutaneous fistula

• Orbital wall osteomyelitis

• Cerebral infection


• Finkelstein M, Legmann A, Rubin PA. Projectile metallic foreign bodies in the orbit: a retrospective study of epidemiological factors, management, and outcomes. Ophthalmology 1997;104:96–103.

• Fulcher TP, McNab AA, Sullivan TJ. Clinical Features and Management of Intraorbital Foreign Bodies. Ophthalmology 2002;109:494–500.

• Ho VH, Wilson MW, Fleming JC, et al. Retained Intraorbital Metallic Foreign Bodies. Ophthal Plast Reconstr Surg 2004;20:232–236.

• Nasr AM, Haik BG, Fleming JC, et al. Penetrating Orbital Injury with Organic Foreign Bodies. Ophthalmology 1999;106:523–532.

• Shelsta HN, Bilyk JR, Rubin PA, et al. Wooden Intraorbital Foreign Body Injuries: Clinical Characteristics and Outcomes of 23 Patients. Ophthal Plast Reconstr Surg 2010;26:238–244.



360.60 Foreign body, intraocular, unspecified

870.4 Penetrating wound of orbit with foreign body


• Rule out intracranial involvement of IOFB prior to removal.

• All organic IOFBs should be removed.

• Inorganic IOFBs that are easily accessible in the anterior orbit should be removed, while those in the posterior orbit can be left in place unless causing orbital complications.

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Nov 9, 2016 | Posted by in OPHTHALMOLOGY | Comments Off on Body Intraorbital

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