Foreign body orbital cyst

To present the clinical and histopathological characteristics of a retained orbital foreign body.

A 34-year-old male was hit in his left eye by a flower stake. At first examination there was a massive haematoma of the left orbit and eyelids, reduced movement of the left eye and a small conjunctival lesion beneath the upper lid. There were no signs of deeper orbital or ocular lesions. During the subsequent months the haematoma disappeared, but increased proptosis and impaired eye movements with diplopia were noticed. One year after the injury, ultrasound and CT-scan revealed an ovoid cystic tumour behind the globe. During surgery the content of the cyst appeared purulent and from the centre of the cyst a foreign body measuring 25 x 13 x 1 mm was removed.

Microscopy of the foreign body showed the typical structure of a decidual leaf. The superficial cells were empty, whereas the centrally located cells contained remnants of cytoplasm. Confined to the border between the empty and the filled cells, a band of cells containing groups of gram positive cocci was noted. Staining for immunoglobulins revealed traces of IgG in the superficial empty cells only.

The high degree of preservation of the leaf and the survival of the cocci may be due to a barrier function of the intact plant cell walls with their high content of cellulose.