Two cases of retention of wooden foreign bodies in orbit of eyeBMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7141.1363 (Published 02 May 1998) Cite this as: BMJ 1998;316:1363
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Retained and missed foreign bodies constitute a real challenge and even though knowledge keeps changing it is papers like these that help other surgeons manage patients inspite of imaging studies pointing towards the absence of foreign bodies. Heightened awareness like the one this article causes and high index of suspicion have been said to be the key in preventing mistakes in managing cases of orbital trauma with suspected foreign body. (1)
Preliminary radiographic readings have been said to often miss or be inconclusive in detecting the foreign body and the use of quantitative CT has been found to be helpful in distinguishing retained wood foreign body from other low-density signals of air or fat.(2)
We have seen a recent case in which a foreign body was missed for over six months even after a CT Scan and in spite of its unprecedented large size.
Time lapse from injury to presentation has been correlated with the size of the foreign body by some authors, (3) but sometimes this may be defied and huge foreign bodies may lie undetected for months as we have seen, the foreign body being masked by surrounding reaction and blood. These kind of cases make it important to look at the literature when faced with such cases, and articles like the present one (4) are helpful especially since such easily available articles from the BMJ help one identify the learning gaps and make an impact in the practice of doctors worldwide by helping doctors make the right referrals even months later. I would like to thank the authors for highlighting important learning objectives through such short and wonderful lessons of the week which remain relevant even years after they have been written.
1) Liu D. Common denominators in retained orbital wooden foreign body. Ophthal Plast Reconstr Surg. 2010 Nov-Dec;26(6):454-8. doi:10.1097/IOP.0b013e3181d92903.
2) Shelsta HN, Bilyk JR, Rubin PA, Penne RB, Carrasco JR. Wooden intraorbital foreign body injuries: clinical characteristics and outcomes of 23 patients. Ophthal Plast Reconstr Surg. 2010 Jul-Aug;26(4):238-44. doi: 10.1097/IOP.0b013e3181bd7509
3) Taş S, Top H. Intraorbital wooden foreign body: clinical analysis of 32 cases, a 10-year experience. Ulus Travma Acil Cerrahi Derg. 2014 Jan;20(1):51-5. doi: 10.5505/tjtes.2014.93876.
4) Tsaloumas, M D, T Potamitis, and E E Kritzinger. “Two Cases of Retention of Wooden Foreign Bodies in Orbit of Eye.” BMJ : British Medical Journal 316.7141 (1998): 1363–1364.
Competing interests: No competing interests