Penetrating orbital injuries from plant material during pond and river diving
A 12-year-old boy presented to an outside hospital with fever, vomiting, and a prominent right eye with a painful, swollen lower lid. He had a history of a penetrating injury sustained while diving head-first into a river 12 days previously. Visual acuity in the right eye was 20/40. He was diagnosed with orbital cellulitis after initial CT scans showed only orbital edema. An orbital exploration revealed an accumulation of pus, but no foreign bodies. After 1 week of treatment with systemic antibiotics, the patient presented to our institution with continued swelling at the injury site. He had an indurated swelling of the lower lid with a discharging sinus, mechanical ptosis, diplopia, eccentric upward displacement of the globe, and 3-mm of proptosis. Adduction and depression were restricted. Repeat CT scan showed a hypodense body surrounded by secondary granulomatous inflammation []. Subsequent exploration recovered a 2-inch wooden foreign body from the right inferomedial orbit. Post-operatively, the patient showed symptomatic improvement with a reduction in proptosis and a visual acuity of 20/30 in the affected eye [].