Chronic Orbital Inflammation Secondary to Paint Injury
Section outline
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High-pressure paint gun injuries to the orbit are rare occupational accidents that may result in delayed and recurrent inflammatory complications. We present a patient who sustained an accidental right orbital injury from a high-pressure spray paint gun. Initial evaluation demonstrated decreased visual acuity, elevated intraocular pressure, an orbital wall fracture, and hyperdense pre- and post septal orbital material on computed tomography. Despite prompt irrigation, broad-spectrum antibiotics, and systemic corticosteroids, the patient developed recurrent episodes of orbital inflammation over a 2.5-month period. Clinically, he experienced eyelid fullness, ptosis, chemosis, diplopia in extreme gaze, and restricted extraocular motility. Imaging revealed persistent high-attenuation intraconal material with associated orbital inflammation. Surgical exploration and debulking were performed due to persistent symptoms. Histopathologic examination demonstrated skeletal muscle and fibrovascular tissue containing birefringent foreign material with a macrophage-predominant inflammatory response. This case highlights the diagnostic and management challenges of orbital paint injuries, which may mimic infection or idiopathic orbital inflammation. Retained paint material can incite a chronic foreign body reaction requiring prolonged follow-up and symptom-guided surgical intervention. Early recognition, aggressive decontamination, systemic anti-inflammatory therapy, and consideration of staged surgical debulking are critical for optimal outcomes.
Presentation Date: 01/22/2026
Issue Date: 01/30/2026
