Cho Won-Kyung, Ko Audrey C, Eatamadi Habibullah, Al-Ali Abdelqadir, Abboud Jean-Paul, Kikkawa Don O, Korn Bobby S
Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology, Shiley Eye Institute, La Jolla, California; Department of Ophthalmology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology, Shiley Eye Institute, La Jolla, California.
Am J Ophthalmol. 2017 Aug;180:46-54. doi: 10.1016/j.ajo.2017.05.018. Epub 2017 May 26.
To emphasize the importance of early detection and radiologic evaluation of retained organic foreign bodies (FBs) in orbital or orbitocranial penetrating injuries by pencil.
Retrospective case series.
A retrospective chart review of patients who had penetrating orbital or orbitocranial trauma at 2 tertiary hospitals was conducted. Patients whose mechanism of injury was penetrating trauma by pencil were included. The patients' demographics, time between initial trauma and detection of foreign body, radiologic images, and resulting sequelae were reviewed.
Four patients were included in this study. All patients were male; 3 were less than 2 years of age and 1 was 34 years old. Accidents were witnessed in 2 cases, and initial detections of FBs were delayed in 3 cases, from 2 days to 7 weeks. Three cases involved the right orbit. Computed tomography (CT) imaging of the head demonstrated penetration of the orbital walls in 3 cases. Three-dimensional CT scans were used to differentiate the penetrating graphite pencil fragments from the orbital wall, and catheter angiography was used in 1 case of suspected orbital apex penetration. Vision was lost in 1 patient while other severe neurologic deficits were fully recovered after removal of FB.
Penetrating injury by pencils to the periorbital structures and delayed detection of retained pencil fragments can result in threat to life and vision. Radiologic examinations are essential to the detection of these retained FBs. Prompt detection and removal of the FBs within 48 hours and treatment with antibiotics can save vision and life.
强调早期发现并对铅笔所致眼眶或眶颅穿透伤中残留的有机异物进行影像学评估的重要性。
回顾性病例系列研究。
对两家三级医院中发生眼眶或眶颅穿透伤的患者进行回顾性病历审查。纳入损伤机制为铅笔穿透伤的患者。对患者的人口统计学资料、初次创伤至发现异物的时间、影像学图像及由此产生的后遗症进行审查。
本研究纳入4例患者。所有患者均为男性；3例年龄小于2岁，1例为34岁。2例事故有目击者，3例初次发现异物延迟，延迟时间为2天至7周。3例累及右侧眼眶。头部计算机断层扫描（CT）成像显示3例眼眶壁有穿透。3例使用三维CT扫描区分穿透的石墨铅笔碎片与眼眶壁，1例怀疑眼眶尖穿透的患者使用了导管血管造影。1例患者视力丧失，其他严重神经功能缺损在取出异物后完全恢复。
铅笔对眶周结构的穿透伤以及残留铅笔碎片的延迟发现可对生命和视力构成威胁。影像学检查对于发现这些残留异物至关重要。在48小时内及时发现并取出异物以及使用抗生素治疗可挽救视力和生命。
