Other orbital injury

Intraorbital foreign bodies are relatively uncommon but must be considered whenever a laceration or puncture wound involves the brow or eyelids. Clinical presentation is variable, ranging from asymptomatic to pain, decreased vision, and diplopia. A complete ophthalmic exam is required to rule out other ocular trauma. A head and orbital CT scan should be performed if intraorbital foreign body is suspected (355). The medial wall and orbital roof are thin and objects may penetrate into the paranasal sinuses or anterior cranial fossa. Not all intraorbital foreign bodies must be removed. Indications for surgery include: organic or copper material, signs of infection, signs of optic nerve compression, fistula formation, large

foreign body, sharp foreign body, and compromise of extraocular muscles or nerves.

Traumatic retrobulbar hemorrhage occurs after blunt trauma to the orbit in which a blood vessel breaks and blood extravasates into the confined space of the orbit. This hemorrhage can cause significant loss of vision from optic nerve compression or acute glaucoma. The patient often presents with pain, acute loss of vision, history of recent trauma, proptosis, and subconjunctival hemorrhage or conjunctival injection. Examination includes visual acuity, pupil examination, color vision, measurement of IOP and evaluation of the central retinal artery. If elevated IOP, decreased vision, or abnormal pupil exam is present, then lateral canthotomy and cantholysis should be performed to minimize the risk of permanent vision loss.