Penetrating Orbital Injury: A Narrative Review for Emergency Clinicians

Penetrating orbit injury is a rare but complex and life-threatening occurrence that may easily be overlooked. Management in the emergency department requires an early multidisciplinary approach but still lacks standard guidelines. This narrative review aims to provide a systematic approach to the management of penetrating orbital injuries for emergency clinicians. Mortality and morbidity are significant due to the orbit's proximity to numerous anatomical structures. Complications may be infectious, ocular, or cerebro-vascular. Their incidence depends on the mechanism of injury, entry point, and object's characteristics such as its shape, composition, and velocity. Non-occult cases are often associated with medial orbital rim or medial eyelid penetration, whereas occult cases mainly present with trivial lateral eyelid injury and could be overlooked. Radiological workup consists of computed tomography or magnetic resonance according to the object's composition. Treatment in the emergency department focuses on initial resuscitation, broad-spectrum antibiotics, and tetanus immunization. Subsequently, early removal of the foreign object in a controlled environment and other specific treatments must be discussed with a multidisciplinary team. Penetrating orbital injury is an uncommon but complex type of head trauma that may be challenging to diagnose. Systematic and multidisciplinary management in the emergency department is crucial to improve overall prognosis.