Common denominators in retained orbital wooden foreign body

To identify some of the common denominators in the diverse presentation of retained orbital wooden foreign bodies.

A review of 9 cases of previously unrecognized retained orbital wooden foreign bodies. Intervention included surgical removal of the foreign bodies in 8 cases and fistula repair in 1 case after spontaneous foreign body extrusion. Outcome measures included return of normal vision, absence of motility disturbance, and resolution of pain, inflammation, eyelid abnormalities, and other symptoms.

Presenting symptoms were diverse and included motility disturbance (5 of 9 patients), conjunctival injection with or without discharge (5 of 9 patients), decreased vision (4 of 9 patients), draining fistula (4 of 9 patients), and localized pain or sensation of tightness in the eyelid (4 of 9 patients). Uncommon symptoms included proptosis (2 of 9 patients), ptosis (2 of 9 patients), lower eyelid retraction (2 of 9 patients), and pain on ocular movement (1 of 9 patients). The interval between the injury and the diagnosis of retained wooden foreign body ranged from 10 days to 42 weeks.

Occasionally, not all of the wooden pieces are removed at the time of initial orbital exploration, despite best efforts. Signs and symptoms of retained orbital wooden foreign body vary greatly. There is no single specific diagnostic or pathognomonic finding. Heightened awareness and a high index of suspicion are keys to proper diagnosis. It is important to have a properly worded consent that includes the possibility of residual wooden foreign bodies and the need for subsequent surgical exploration.