Orbital foreign body

Case contributed by Laughlin Dawes
Diagnosis certain

Patient Data

Age: Adult
Gender: Male

Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

CT brain


Single image from an axial CT scan demonstrates a mostly gas density object with a metal tip (a ballpoint pen) projecting through the orbit, medial to the globe, through the lateral orbital wall just lateral to the superior orbital fissure and into the temporal lobe.

No large hemorrhage is present.

A small amount of gas is seen at the fracture site. 

Case Discussion

This patient presented with a self-harm injury. 

The pen missed the optic nerve, the middle cerebral artery and any eloquent brain. A cerebral angiogram was performed which was normal except for truncation of the ophthalmic artery (not shown). The pen was removed under fluoroscopic guidance. Upon removal, there was brisk bleeding from the ophthalmic artery. Endovascular embolization of the bleeding vessel was performed with coils, with good result. The patient’s pupil remains reactive, suggesting a good prognosis for the optic nerve and the patient’s vision. 

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