Orbital foreign body
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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.
This patient presented with a self-harm injury.
The pen missed optic nerve, 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.