Diagnosis and treatment of penetrating orbital cranial foreign body injuries.

Penetrating transorbitocranial injuries can occur in a variety of circumstances, and heightened suspicion is required to identify the foreign body, particularly in the setting of a trivial external wound. In “5-year-old girl with left upper eyelid swelling,” Shoeb and colleagues1 draw attention to an infrequent but important and potentially life-threatening injury. A multidisciplinary team approach is mandated to provide expedient yet cautious and safe treatment. In the reported case, an ocular motility deficit and palpable foreign object led to appropriate neuroimaging with computed tomography (CT) and identification of the object. This is, however, infrequently the case; in the review of 23 wooden intraorbital foreign body injuries cited in the current report, the foreign object was identified by the radiologist on initial imaging in only 61% of cases.2 Five cases were read as “possible foreign body” and 3 were read definitively as “no foreign body.” Thus the clinician caring for the patient should maintain a high index of suspicion and is best positioned to review the imaging obtained and to consider secondary studies, such as magnetic resonance (MR) and vascular imaging. This will facilitate prompt identification and treatment of a retained foreign body, preventing delay in diagnosis and subsequent sequelae, such as infection, hemorrhage, or death.