|Year : 2019 | Volume
| Issue : 2 | Page : 158-159
A rare and unusual case of cycle pedal in the orbit
Malarvizhi Raman, A Anuradha, K Vasumathi, S Sheela, C Nisha
Department of Squint and Neuro Ophthalmology, Regional Institute of Ophthalmology and Government Ophthalmic Hospital, Chennai, Tamil Nadu, India
|Date of Web Publication||10-Sep-2019|
Dr. Malarvizhi Raman
Regional Institute of Ophthalmology and Government Ophthalmic Hospital, Chennai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
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 2020 Jun 1];57:158-9. Available from: http://www.tnoajosr.com/text.asp?2019/57/2/158/266388
| Introduction|| |
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.
| Case Report|| |
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 3: Computed tomography scan showing fracture in the floor of the orbital wall|
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| Discussion|| |
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. CT scan can assess the size, consistency, and localization of the foreign body. 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.,
| Conclusion|| |
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
Conflicts of interest
There are no conflicts of interest.
| References|| |
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]