PHOTO ESSAY
Orbital Foreign Body
A
MAN COMPLAINED OF
severe pain and de-
creased vision in the
right eye after being
stabbed with a pen-
cil during an altercation 1 week be-
fore being seen by the ophthalmol-
ogy service. A laceration to the upper
eyelid had been closed on the day of
the altercation, but no imaging stud-
ies had been obtained. A computed
tomographic image obtained at the
time of the ophthalmology service
referral showed a foreign body (FB)
abutting the globe (Figure 1). The
patient underwent surgery that
night, and a 4.6-cm section of a No.
2 pencil was removed (Figure 2).
COMMENT
Physicians must have a low thresh-
old for obtaining imaging in cases of
possible orbital FB. In the present
case, failure to obtain an image sig-
nificantly delayed definitive treat-
ment. In general, computed tomog-
raphy is considered the imaging
modality of choice for evaluating or-
bital FB.1
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Size, location, and composition
are considerationsfordeterminingthe
need to remove an orbital FB. Glass,
stone, and most metals are inert and
usually well tolerated; copper and its
alloys (eg, brass) are important excep-
tions. Organic materials (especially
wood) are associated with a granulo-
matous reaction and have a high like-
lihood of eventual fistulization.1
Surgery to remove an orbital FB
is not without risks: failure to locate
the FB is not uncommon; the object
may fragment during removal; and in-
advertent injury to orbital structures
can occur. Given the risks attendant
in orbital FB surgery, careful consid-
eration must be given to “watchful
waiting.”1 Orbital FBs that are inert
and small are the best candidates for
this strategy, whereas orbital FBs that
are immunogenic and/or large likely
will require surgical management.
Steven B. Flynn, MD, PhD
Thomas C. Cannon, MD, MPH
Tracey Schmucker, MD
Romona Davis, MD
Christopher Westfall, MD
Little Rock, Ark
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296
The authors have no relevant finan-
cial interest in this article.
This study was supported in part
by an unrestricted grant from the Re-
search to Prevent Blindness, Inc, New
York, NY, and the Pat and Willard
Walker Eye Research Center, Jones
Eye Institute, University of Arkansas
for Medical Sciences, Little Rock.
Corresponding author: Chris-
topher Westfall, MD, Department of
Ophthalmology, Jones Eye Institute,
University of Arkansas for Medical
Sciences, 4301 W Markham, Slot 523,
Little Rock, AR 72205-7199.
REFERENCE
1. Cooper WC, Haik BG, Brazzo BG. Management of
orbital foreign bodies. In: Nesi F, Lisman R, Levine
M, eds. Smith’s Ophthalmic and Reconstructive
Surgery. 2nd ed. St Louis, Mo: Mosby–Year Book
Inc; 1998:260-268.
 Figure 1. Computed tomographic image demonstrating a right orbital foreign body passing through the
lamina papyracea and ethmoid sinus, with one end of the object embedded in the right nasal septum and
the other abutting the globe. More rostral images demonstrated that the foreign body did not violate the
fovea ethmoidalis.

Figure 2. Intraoperative photograph of the foreign body (star), 4.6 cm long, that was removed from the
right orbit. The entrance wound (black arrow) and orbitotomy site (white arrow) are also shown. The ruler
is in millimeters.

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