Intraorbital Wooden Foreign Body

A 63-year-old male with a history of decreased extraocular motility, binocular diplopia and proptosis presenting to the ED after trauma with a palm tree branch a few days before presentation. 

The patient presents 6 days after trauma with a tree branch. He had a 360-degree chemosis and decreased extraocular motility in all gazes. This resulted in subjective binocular diplopia which was also the patient’s main symptom. There was no decrease in vision or any intraocular findings. Radiologic imaging for the patient revealed a soft tissue density in the retrobulbar space which resembled a retrobulbar hematoma. The patient was managed medically with no further intervention. He was then lost to follow up. 1.5 years later he presents to the ED again with worsening symptoms, still with decreased extraocular muscle movement but now also with optic nerve edema, choroidal folds and minimal decrease in vision. Repeat imaging showed retrobulbar inflammation probably secondary to foreign body. The patient was managed medically with systemic steroids and intraorbital triamcinolone injections. The foreign body surprisingly migrated and extruded on its own 2.5 years after the initial injury.

Guidance in managing intraorbital wooden foreign bodies is limited due to infrequent occurrence. Depending on symptomatology and location they will be managed medically and by observation but most likely will have to be surgically excised. They can create orbital infection and inflammation, can migrate but might also self-extrude. Any trauma with a suspected retained wooden foreign body must be followed up closely to prevent irreversible sequela. 

Presentation Date: 03/19/2020

Issue Date: 08/01/2020