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Two plant
foreign bodies into the orbit were reported: One was diagnosed lately and this
extracted foreign body on the 24th day of onset. The other was
extracted the foreign body on the 22nd day of onset. Some considerations
on prevention, on primary eye care, paraclinical and clinical features, medical
and surgical treatments were discussed especially for helping medical doctor in
district hospital level.
Purpose: Report of two cases of plant foreign body:
·
A branch of eucalyptus tree is
perforated into the lower eyelid, next to the globe complicated orbital abscess
and diplopia. This case was diagnosed and was operated for removing of the
foreign body on day 24th from onset.
·
A twig which is perforated the upper
eyelid complicated orbital abscess and ptosis was delayed 3 weeks from the
onset because of closed unhealed wound. The surgery of removal foreign body on
day 22nd from onset and improve complications.
Design: Report of two cases of clinical diagnosis
and intervention.
Diagnosis: Main measures: clinical signs, paraclinical
and patient’s history.
Paraclinical:
·
X-ray: No sign is detected as twigs did
not opacity in X-ray.
·
Ultrasound: Showed foreign bodies in the orbit, but does not specify the
shape, the size of the object.
Diagnosis:
·
Case 1: Foreign body into the orbit
through lowerlid caused abscess and diplopia
·
Case 2: Foreign body into the orbit
through upper lid caused abscess and ptosis.
Interventions: Surgery and results:
Case 1:
Foreign body into the orbit through lower lid.
On day 24th
since foreign body into the eye: Local anesthesia and conjunctiva. Surgical
exploration was performed by through wounded site extending along the outer
eyeball, in positions 3-4 O’ clock, freeing abscess pus. After pus cleaning,
strabismus hook was used for detecting foreign body that is located directly
beneath the lower rectus muscle, stabbed in the globe and orbit. Then the
foreign body was extracted by strabismus hook. Foreign objects is a twig tree
with size: 5 mm (diameter) × 15 mm (length). One week after surgery: the
abscess collapse, decreased conjunctiva hyperemia, less bruising lid, no
diplopia. Three weeks after the removal of foreign right eye completely back to
normal, vision 1/10, IOP 17 mm Hg.
Case 2:
Foreign body into the orbit through upper lid.
On day 22nd
since foreign body into the eye: Patients with moderate ptosis with lid slit 25
mm, tumor on lower lid with 5 mm (diameter) × 10 mm (length). Local anesthesia.
Abscess liberation to remove pus and foreign bodies. Foreign body is a dry tree
twig with size 5 mm (diameter) × 10 mm (length). One week after surgery: lid
slit 4 mm, 8 mm 2 weeks: 2 eyes open near normal.
Conclusion:
1.
The initial management and closely
monitor patients every day has an important role to remove the foreign bodies
as soon as possible, to minimize complications contribute to the success of
treatment.
·
Careful detail patient’s history object
is especially small sized such as twigs of tree.
·
Combining the clinical signs: deeply
abscess orbit, using strong pressing on the wound to detect the pus out,
hyperemia of conjunctivitis, diplopia, ptosis…after trauma.
3.
Perform surgery for abscess debridement
as well as detect foreign body helping remove foreign bodies sooner with
results expected.
Keywords: Plant foreign body, Orbital abscess, Ptosis,
Diplopia, Surgical treatment
INTRODUCTION
Penetrating eye injuries due to foreign body
often cause serious damage to the eyes and vision. In the case of contrast
object can be determined by x-rays [1]. In the case of object cannot be
determined by x-rays, ultrasound image [2,3], computerized tomography (CT) can
be used to confirm [4]. The treatment consists of surgical removal of foreign
body, damage recovery and medical treatment of complications such as infection
[5,6]. The initial management is removed of foreign intervention as soon as
possible to minimize complications. In most of the cases the patient with plant
foreign body into orbit to delay in hospital admission cannot be diagnosed by
x-ray need to be closely monitored to avoid forgotten foreign body. These are
contributing to the success treatment [6-8].
Two cases of plant foreign bodies were
reported in this paper.
CASES REPORT
Case 1: RE=Foreign body into orbit through
lower lid [8]
Three weeks ago, a 64 year old male patient,
farmer, while working to cut eucalyptus trees and suddenly a dry tree twigs snapped and crashed
heavily in his right eye. Patients with bleeding in the eye and was taken to an
eye
specialist for treatment locally. According to
the family of the patient, this staff can get here is a very small piece of branch tree (twig) from patient’s eye and medical
treatment for more than 2 weeks. During this time the patient's condition did
not reduce that tend to increase such as: touching the lower eyelid a tumors
with tenderness, pus throught the wound hole intermittent then continuous, visual acuity blured, diplopia relief but patient’s
feeling was more
uncomfortable. Patient had seeked himself referral to treatment.
Examination: Right eye: Visual acuity 1/10,
intraocular pressure 17 mm Hg (Schiotz). Upper lid: normal, lower lids: a bruise wound
at the 1/3 corners of
the nose lid with a hard
tumor, about 2 mm in diameter, pressing against the yellow pus appeared
throught the wound hole. The conjunctiva was intact. There was not
any traces of foreign
bodies in the conjunctiva. Oculomotor: movement somewhat limited and diplopia.
The pupil was 3 mm in diameter, round, regular, direct light reflex (+). The anterior chamber
and crystalline lens were clear. Fudus examination was
normal. Left eye: Visual
acuity 3/10, intraocular pressure 17 mm Hg. Oculomotor: normal. The other part
of the eye was normal. X-ray: no sign is detected
[1]. Ultrasound: A wave showed for strange body, but does not specify the
shape, the size of the object [2,3].
Diagnosis: RE= Foreign body into orbit through lower lid caused abscess and diplopia complications.
Treatment: Ciprofloxacin 500 mg ×
2/day-combined methylprednisolone 16 mg/day for 1 week.
Surgery: Day 24th since foreign body into the eye: Local anesthesia and conjunctiva.
Surgical exploration by an incision extending hole along the outer wall of the eyeball, in positions 3-4
O’ clock, freeing abscess pus was done. After pus cleaning clearly, strabismus hook was used to detecting foreign body that was located directly beneath the globe, the lower rectus muscle. Then this foreign body was extracted by hook through this hole. From the mouth hole to located foreign
object is about 25 mm. Foreign object is a dry twig of tree with size, size: 5 mm diameter, 15 mm
length. After surgery a week: abscess collapse, less conjunctival hyperemia, less bruising eyelid, no diplopia. Three weeks after the
removal of foreign body the wound was healed. By 3 weeks after treatment right eye completely back to normal, vision
1/10, IOP=17 mm Hg (Figure 1 and the
patient's right eye).
Case 2: LE=Foreign
body into the orbit through upper lid
Three weeks ago, a 34 year old male patient while working he had fallen and a twig of dry coconut tree had suddenly
perforated into the
orbit through upper
lid of his left eye.
The patient visited at the health village station several times with chief complain: the eye lid dropping and difficult to open
and an unsealed wound with pus
while pressing. Patient was sent to eye doctor after 3 weeks from here. On the eye examinations: Patients with moderate ptosis,
lid slit 25 mm -
tumor size = 5 mm diameter. Visual acuity RE = 10/10-LE =
10/10 but feel uncomfotable in daily activities because of ptosis. X-ray: no sign is detected [1].
Ultrasound: A wave showed for strange body,
but does not specify the shape, the size of the object [2,3].
Diagnosis: LE= Foreign body into orbit throught upper lid caused abscess and moderate ptosis complications.
Treatment: Antibiotics: Ciprofloxacin 500 mg ×
2/day combined methylprednisolone 16 mg/day for 1 week [5-7].
Surgery: Local anesthesia eyelid. An incision
through the tumor 12 mm was opened and a strabismus hook
was used for detecting
foreign body. After abscess
debridement, a foreign body located
at
internal rectus muscle and was removed by this hook. The deepth
position of foreign body was about 22 mm. Foreign body is a dry branch of coconut with size 5 mm × 10 mm.
One week after surgery: lid slit=4 mm, no diplopia. 2 weeks latter: lid slit=8mm and both eyes open normally (Figure
2 and the patient's left eye).
PREVENTION
Two cases are
accidents of working without wearing glasses for protecting eyes because of
famers living in rural area.
It is
recommended to wear safety spectacles in work as it is necessary to minimize
this accident.
CONCLUSION
·
The initial management and close
monitoring of patients each day with the foreign body into the orbital eye have
an important role in order to remove the foreign as soon as possible, to
minimize complications contribute to the success of treatment.
·
In case of the patient came lately with
complications: Take carefully the patient‘s history as well as using
paraclinical signs must be necessary for confirm foreign body. In the case of
object is twig of tree, x-ray is not useful, a combination of clinical signs
and a probe of ultrasound may be useful in diagnosis.
·
Perform abscess debridement and liberate
pus as well as to remove foreign bodies with results expected (Table 1).
1.
Lloyd G (1987)
Radiology and the orbit. In: Clinical Ophthalmology. Wright: Bristol, pp:
87-96.
2.
Kendall CJ (1990)
Ophthalmic echography. Slack.
3.
Restori M (1987)
Ultrasonography of the eye and orbit. In: Clinical Ophthalmology. Wright:
Bristol, pp: 81-86.
4.
De Potier P (1998)
Orbital imaging. In: Ophthalmology Secrets. Henley & Belfus, pp: 231-233.
5.
Vander JF, Gault JA
(1998) Ophthalmology secrets. Henley & Belfus, pp: 76-83.
6.
Maus (1998) Orbital
inflammations marton. In: Ophthalmology Secrets. Henley & Belfus, pp:
244-247.
7.
Dieu D (2003) Case
report: An orbital foreign body case. Vietnam Ophthalmology Journal - Eye
Institute Hanoi 10: 90-92.
8.
Dieu D (2018) The plant
foreign body into orbit: Diagnosis and treatment. Int J Res Publication 3: 3.
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