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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 57  |  Issue : 2  |  Page : 158-159

A rare and unusual case of cycle pedal in the orbit


Department of Squint and Neuro Ophthalmology, Regional Institute of Ophthalmology and Government Ophthalmic Hospital, Chennai, Tamil Nadu, India

Date of Web Publication10-Sep-2019

Correspondence Address:
Dr. Malarvizhi Raman
Regional Institute of Ophthalmology and Government Ophthalmic Hospital, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_33_19

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  Abstract 


A 58-year-old male presented with injury in the left eye by falling over a cycle pedal. On presentation to the casualty, the cycle pedal was found penetrating onto the superomedial aspect of the left orbit. The cycle pedal was removed in toto, and computed tomography brain with orbital cuts revealed fracture in the orbital floor, maxilla, and nasal bone. Upper-lid tear was sutured, and visual acuity was 20/30 no improvement in glass, no improvement in pinhole (NIG, NIP). Thus, immediate extraction of the foreign body resulted in better visual and cosmetic outcome.

Keywords: Cycle pedal, intraorbital foreign body, largest, metallic, unusual


How to cite this article:
Raman M, Anuradha A, Vasumathi K, Sheela S, Nisha C. A rare and unusual case of cycle pedal in the orbit. TNOA J Ophthalmic Sci Res 2019;57:158-9

How to cite this URL:
Raman M, Anuradha A, Vasumathi K, Sheela S, Nisha C. A rare and unusual case of cycle pedal in the orbit. TNOA J Ophthalmic Sci Res [serial online] 2019 [cited 2019 Sep 22];57:158-9. Available from: http://www.tnoajosr.com/text.asp?2019/57/2/158/266388




  Introduction Top


Penetrating orbitocranial injuries with large foreign bodies is a rare entity. They may result in severe structural and functional damage to the eye and other orbital contents. The management and prognosis depends on the location and nature of the foreign body.[1]


  Case Report Top


A 58-year-old male presented with a history of fall over a bicycle, and the cycle pedal penetrated his left eye (LE) [Figure 1]. He was brought to the casualty by ambulance services after detaching the pedal from the cycle. On presentation, the patient was conscious, and the general condition was stable. The cycle pedal was found buried into the superomedial aspect of the left orbit. Ocular examination of the LE showed periorbital edema with hematoma without globe perforation. The right eye was normal. Immediately, the patient was taken to the emergency operation theatre; after strict aseptic precautions and hemostasis, the cycle pedal was pulled out by gentle traction [Figure 2]. Pupillary reaction was monitored during the maneuver. The cycle pedal measured about 12 cm in length and 3 cm in width. The patient was sent for urgent computed tomography (CT) brain with orbital cuts which revealed a fracture in the orbital floor with hyperdensity noted in the maxillary sinus, suggestive of hemosinus [Figure 3]. Laceration of size 4 cm * 1cm *12 cm extending from the medial end of eyebrow to the upper eyelid margin was sutured in layers. The patient was referred for neurology, ENT, and faciomaxillary surgeons' opinion to rule out other injuries. The patient was treated with parenteral antibiotics and was instructed not to blow the nose. Lid edema and hematoma gradually subsided. On the 3rd postoperative day, visual acuity of the LE was 20/30 NIGNIP. Extraocular movements were full without diplopia, pupil size 3 mm, reacting to light, fields, colour vision, fundus was normal [Figure 4]. Surgical management of the fracture was deferred as there was no optic nerve compression or muscle entrapment or cosmetic disfigurement. The patient was started on oral antibiotics namely tablet ciprofloxacin 500 mg BD for 5 days and tablet prednisolone 40 mg OD for 10 days. At 2-week follow-up, the patient recovered with visual acuity of 6/6 and full extraocular movements.
Figure 1: Cycle pedal in the orbit

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Figure 2: Cycle pedal after removal from the eye

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Figure 3: Computed tomography scan showing fracture in the floor of the orbital wall

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Figure 4: Postoperative picture

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  Discussion Top


We present this case to highlight one of the largest (12 cm × 3 cm) and unusual (cycle pedal) foreign bodies. Within 1 h of injury, the cycle pedal was removed. Despite the large size of the foreign body, the globe was intact. However, because there was no ocular injury, the patient had good visual acuity without any major complication except for fracture of the orbital wall. Large orbital foreign bodies are rare and uncommon and occur after high-velocity injury. Large orbital foreign bodies are commonly associated with vision loss. Foreign bodies can be metallic or nonmetallic.

Surgical intervention in a case with intraorbital foreign body is indicated usually in the presence of sharp foreign body, infection, proptosis, restricted motility, optic nerve compression, or when adjacent structures are compromised.[2] CT scan can assess the size, consistency, and localization of the foreign body.[3] In our case, CT scan was useful to identify the orbital wall fractures. Longest foreign body reported in the literature is a wooden stick penetrating the sino orbital region measuring 9.5 cm * 0.8 cm * 0.8 cm and second largest foreign body reported is a wooden stick measuring 8.5 cm long.[4],[5]


  Conclusion Top


In this case, a cycle pedal was embedded in the superomedial aspect of the orbit with no involvement of the globe, both structural and functional. Thus, we advocate immediate extraction of the foreign body to improve the visual prognosis and outcome.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Moretti A, Laus M, Crescenzi D, Croce A. Peri-orbital foreign body: A case report. J Med Case Rep 2012;26:6:91.  Back to cited text no. 1
    
2.
Finkelstein M, Legmann A, Rubin PA. Projectile metallic foreign bodies in the orbit: A retrospective study of epidemiologic factors, management and outcomes. Ophthalmology 1997;104:96-103.  Back to cited text no. 2
    
3.
Kubal WS. Imaging of orbital trauma. Radiographics 2008;28:1729-39.  Back to cited text no. 3
    
4.
Mundra RK, Gupta Y, Raikwar RS, Tyagi S. Longest wooden stick penetrating sino-orbital region: Unbelievably sparing vital structures. J Otol Rhinol 2015;4:1.  Back to cited text no. 4
    
5.
Tuppurainen K, Mäntyjärvi M, Puranen M. Wooden foreign particles in the orbit – Spontaneous recovery. Acta Ophthalmol Scand 1997;75:109-11.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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Abstract
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Discussion
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