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Published on: February 29, 2020
Incidental finding of an orbital foreign body in a child with microcephaly and developmental delay
Maria J Hall1, Megan R Thomas, Mina Shekarchian
1Blenheim House Child Development Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK.
Insights
A retained plastic toy caused a deep orbital infection in a child with microcephaly. Surgical removal of the foreign body led to recovery, but granulomatous reactions persist.
Area of Science:
- Ophthalmology
- Pediatric Neurology
- Foreign Body Injury
Background:
- Microcephaly and global developmental delay present diagnostic challenges in pediatric cases.
- Orbital and preseptal cellulitis can arise from penetrating or superficial injuries.
- Foreign bodies in the orbit require prompt identification and management to prevent complications.
Observation:
- A 3-year-old boy with microcephaly presented with an orbital lesion.
- History revealed a prior fall onto a plastic toy and subsequent preseptal cellulitis.
- Intermittent eyelid edema and erythema were noted post-cellulitis.
Findings:
- MRI revealed an ill-defined, enhancing lesion in the left superolateral orbit.
- Anterior orbitotomy identified a large foam plastic foreign body.
- Histopathology indicated a persistent granulomatous foreign body reaction.
Implications:
- Retained orbital foreign bodies can mimic or complicate orbital infections.
- Granulomatous reactions to foreign materials can cause chronic inflammation and edema.
- The etiology of the child's microcephaly and developmental delay remains undetermined.
Abstract:
A 3-year-old boy underwent investigations for microcephaly and global developmental delay. An MRI scan identified an ill-defined enhancing lesion in the left superolateral orbit. On subsequent questioning his parents reported that he had been admitted to a neighbouring hospital 2 months earlier with left-sided preseptal cellulitis following a fall onto a plastic toy. Following the episode of cellulitis he developed intermittent mild erythema and oedema of the left upper eyelid for which his parents had not sought further medical attention. The child was admitted for an anterior orbitotomy via a skin-crease approach that identified a large foam plastic foreign body. He made a good recovery from his surgery although he has had intermittent upper eyelid oedema attributed to a persistent granulomatous foreign body reaction. No underlying cause for his microcephaly and delayed development has yet been identified.
