Penetrating orbital injuries from plant material during pond and river diving
A 6-year-old boy presented with a history of penetrating injury to the upper left eyelid sustained while diving head-first into a pond. On presentation, he could only perceive hand movements very close to his face. Since a computed tomography (CT) scan done at this time did not reveal the presence of any foreign body, the patient was treated for orbital cellulitis. One month later, he returned reporting discharge from the eyelid wound, which had formed a fistula. He also had unresolved proptosis and lid edema. A repeat CT scan showed an abscess with an empty sinus tract but no distinguishable foreign body []. The patient subsequently developed septic arthritis of the left hip joint, which was treated separately. Subsequent re-evaluation of the patient's left eye revealed a queried perception of light, relative afferent pupillary defect, optic disc pallor, and inferotemporal displacement of the globe. A superonasal quadrant granulation mass was observed from the non-healing wound, but elevation and depression of the globe in adduction were minimally restricted. Re-evaluation of the CT scan showed a single hypodense superomedial lesion corresponding to the previously noted sinus tract. A superomedial orbitotomy resulted in the removal of 4 wooden foreign bodies, each approximately 1.5 inches in length. By post-operative day 5, the patient's edema and proptosis had resolved. At 1-month follow-up, the eyelid wound was completely healed, and left eye visual acuity had improved to 20/120.