Orbital foreign body
Introduction
Introduction Common foreign bodies in eyelid foreign bodies include metal shrapnel, airsoft bullets, or wood and bamboo chips. There may be local swelling and pain. If a purulent infection is combined, it can cause cellulitis or sputum. Since the metal foreign bodies in the sputum are mostly wrapped by soft tissue, and the deep sacs have fine structures such as nerves, blood vessels and muscles, such foreign bodies in the deep part of the sputum may not be barely extracted. Botanical foreign bodies can cause chronic suppurative inflammation and should be removed as soon as possible. There are bone wall protection around the eyelids. Most of the intraorbital foreign bodies enter from the front, most of them pass through the eyelids or conjunctiva, enter the deep eyelids between the eyeballs and the iliac crests, and a few perforations of the eyeballs enter the sputum.
Cause
Cause
The cause of foreign bodies in the eyelids:
Mostly caused by accidents.
Examine
an examination
Related inspection
Eye and sacral area CT examination ophthalmologic examination
1. Diagnosis based on characteristic performance:
It is important to clarify the history of trauma. Some patients have a history of eyelid penetrating injury to diagnose; however, some patients, especially children, have denied a history of trauma; others have passed through the conjunctiva, are covered by hemorrhage and edema, are missed at the initial diagnosis, or the wound has healed. After a period of time, sputum cellulitis, sputum abscess or fistula, should be highly suspected of foreign body inside the sputum, if necessary, should remind patients whether there is a history of trauma.
Periorbital fistulas form repeated cellulitis and fistula formation, and plant foreign bodies should be highly suspected. When the manifold is flushed, foreign matter may sometimes be discharged.
2. X-ray inspection:
Metal foreign matter can be displayed, but it is not developed for stones, glass, plastics, and plant-like foreign matter.
2. Ultrasound examination:
It is unique to foreign objects in the ball, because the vitreous in the eyeball is an anechoic zone. Under such a background, the positive rate of foreign matter is high. However, both foreign bodies and eyelid fat are strong echoes, and the sound energy is attenuated. Only large foreign bodies near the ball wall or bleeding around the foreign body, granuloma, and low echo areas can be found. Clinically, plant-based foreign bodies are found to have a low rate of ultrasound.
3. CT scan:
CT scan: According to the experimental metal foreign body CT value is greater than +3000H, glass CT value +300~600Hu, plastic CT value 0~20Hu, wood CT value 199~50Hu. CT can display deep or shallow metal foreign bodies in the eyelids. The minimum volume that can be displayed is: steel 0.14 mm, copper 0.09 mm, lead 1.69 mm, and wood 1.57 mm. Because the metal density is much higher than the fat in the sputum, the contrast is large, easy to be found, and radioactive artifacts often occur. The impact on the accurate positioning of foreign bodies. It is determined that the foreign matter adjacent to the ball wall has difficulty in the ball or outside the ball; for a plurality of foreign objects in the ball, the artifact of the larger foreign object can shield the small foreign object. The CT value of the plant foreign body is negative, and the foreign matter in the background of the low density of the fat is unclear, and even if the foreign matter reaches 2.5 mm×2.5 cm, it cannot be displayed. After forming a granuloma or fibrous envelope around a foreign body, the fiber wall has a high CT value and exhibits a high density. If the foreign body is large, there is bleeding around, and the granulation is high-density area contrast, the plant foreign body is shown as a low-density area. When the foreign matter is small, it is difficult to display foreign matter due to the foreign matter being wetted by the tissue fluid and volume-averaged. If there are other high-density objects in the woody foreign objects, such as pencils, it can be displayed.
4. MRI examination:
The display of non-magnetic foreign bodies, especially plant foreign bodies, is superior to CT. The fat in the sputum is high signal and the foreign matter is low signal or no signal, which is easy to be found on T1WI.
Diagnosis
Differential diagnosis
Eyelid foreign body confusing symptoms:
1. Orbital foreign body: more common in blast injury, the upper and lower eyelids can be covered with fine powder of slag, dust and sand, and larger foreign objects can be clipped with tweezers.
2. Conjunctival foreign bodies: common dust, coal dust, etc., more hidden in the lower ditch of the seesaw, sacral and half-moon folds, foreign body rubbing the cornea can cause irritation. After using the topical anesthetic to spot the eye, wipe off the foreign body with a cotton swab and then apply antibiotic eye drops.
3. Corneal foreign body: See more coal dust and iron filings, and obvious irritation, such as tingling, tearing, eyelids, etc. Iron foreign matter can form rust spots, and plant foreign matter can easily cause infection. For shallow foreign body of the cornea, under the surface anesthesia, wipe it with a saline wet cotton swab. Deeper foreign matter can be removed with a sterile injection needle. If there is rust, try to scrape it off once. For a plurality of foreign objects, it can be taken out in stages, that is, the exposed shallow foreign matter is discharged first, and the foreign matter buried in the deep layer of the cornea can be temporarily not treated. If the foreign body is large and has partially penetrated the cornea into the anterior chamber, foreign body extraction should be performed in the operating room, and the corneal wound should be sutured if necessary. Sterile operation should be strictly performed when picking out corneal foreign bodies. After taking out foreign body, take antibiotic eye drops or eye ointment, bandage the injured eye and promote corneal healing.
