Endoscopic techniques for removal of intraorbital foreign bodies - a clinical series

Management of intraorbital foreign bodies (IOFBs) is challenging due to the confined space and proximity of neurovascular and ocular structures. The increasing adoption of endoscopic techniques has expanded minimally invasive treatment options. We report operative corridors, indications, and outcomes of various endoscopic approaches in a consecutive series.

We analyzed 16 patients with IOFBs treated between 2015 and 2023 at a tertiary university center. All procedures were performed using exclusively endoscopic techniques. Eleven IOFBs were metallic and five organic. Surgical strategy was individualized according to IOFB location and included endoscopic transethmoidal, transmaxillary, transconjunctival, and retrocantal approaches. Neuronavigation was used in all cases with adjunctive fluoroscopy or ultrasonography when indicated.

Nine IOFBs were intraconal and seven extraconal. Successful removal was achieved in 13 of 16 patients. All unsuccessful attempts involved small, non-ferromagnetic air-gun pellets located deep in the posterior orbit; these patients remain under observation without delayed inflammatory complications. No new postoperative visual deterioration or neurological deficits occurred. Transient periorbital edema was observed in all patients and resolved spontaneously. Cosmetic outcomes were satisfactory in all but one case with extensive initial soft-tissue loss. In three patients with presumed orbital tumors, removal of wooden fragments led to regression of inflammatory masses on follow-up.

Endoscopic techniques represent a valuable alternative to traditional open approaches, especially for deep-seated lesions. The optimal approach should prioritize the most direct path to the target, avoiding critical structures such as the optic nerve, extraocular muscles, ciliary nerves and vessels to minimize the risk of permanent deficits.