We report a case of traumatic optic neuropathy accompanying a grease gun injury to the orbit. A 48-year-old man with a grease gun injury visited our clinic with decreased visual acuity, proptosis and limited extraocular movement (EOM). Orbital CT revealed a crescent mass of fat in the medial intraconal space. The grease was exuded from a lacerated conjunctival wound. The visual evoked potential (VEP) test demonstrated a decreased response in the left eye. Proptosis and EOM were improved after surgical removal of the grease. Systemic high-dose corticosteroid therapy was administered for suspected traumatic optic neuropathy, after which VEP nearly recovered, while visual acuity was slightly improved. A second surgery for traumatic cataract did not further improve visual acuity.
*Accidents, Occupational ; Evoked Potentials, Visual ; Eye Injuries, Penetrating/diagnosis/*surgery ; Humans ; *Lubricants ; Male ; Optic Nerve Injuries/diagnosis/*surgery ; Orbit/*injuries ; Visual Acuity

We report a case of a retained graphite anterior chamber foreign body that was masquerading as stromal keratitis. A 28-year-old male visited with complaints of visual disturbance and hyperemia in his right eye for four weeks. On initial examination, he presented with a stromal edema involving the inferior half of the cornea, epithelial microcysts, and moderate chamber inflammation. Suspecting herpetic stromal keratitis, he was treated with anti-viral and anti-inflammatory agents. One month after the initial visit, anterior chamber inflammation was improved and his visual acuity recovered to 20/20, but subtle corneal edema still remained. On tapering the medication, after three months, a foreign body was incidentally identified in the inferior chamber angle and was surgically removed resulting in complete resolution of corneal edema. The removed foreign body was a fragment of graphite and he subsequently disclosed a trauma with mechanical pencil 12 years earlier. This case showed that the presence of an anterior chamber foreign body should always be considered in the differential diagnosis of idiopathic localized corneal edema.
Adult ; Anterior Chamber/*injuries/pathology ; Corneal Stroma/*pathology ; Diagnosis, Differential ; Eye Foreign Bodies/*diagnosis/physiopathology/surgery ; Eye Injuries, Penetrating/*diagnosis/physiopathology/surgery ; *Graphite ; Humans ; Keratitis/*diagnosis ; Male ; Ophthalmologic Surgical Procedures ; Visual Acuity

Intraorbital wooden foreign bodies may present difficulties in diagnosis due to their radiolucent nature. Delayed recognition and management can cause significant complications. We present a case report that demonstrates these problems and the sequela that can follow. A 56-year-old man presented with a 3-cm laceration in the right upper eyelid, sustained by a slipping accident. After computed tomography (CT) scanning and ophthalmology consultation, which revealed no fractures and suggested only pneumophthalmos, the wound was repaired by a plastic surgery resident. Ten days later, the patient’s eyelid displayed signs of infection including pus discharge. Antibiotics and revisional repair failed to solve the infection. Nearly 2 months after the initial repair, a CT scan revealed a large wooden fragment in the superomedial orbit. Surgical exploration successfully removed the foreign body and inflamed pocket, and the patient healed uneventfully. However, the prolonged intraorbital infection had caused irreversible damage to the superior rectus muscle, with upgaze diplopia persisting 1 year after surgery and only minimal muscle function remaining. We report this case to warn clinicians of the difficulties in early diagnosis of intraorbital wooden foreign bodies and the grave prognosis of delayed management.
Anti-Bacterial Agents ; Delayed Diagnosis ; Diagnosis ; Diplopia ; Early Diagnosis ; Eye Foreign Bodies ; Eye Injuries, Penetrating ; Eyelids ; Foreign Bodies* ; Humans ; Lacerations ; Middle Aged ; Ophthalmology ; Orbit ; Prognosis ; Suppuration ; Surgery, Plastic ; Tomography, X-Ray Computed ; Wounds and Injuries

PURPOSE: Ocular perforation during lid anesthesia is rarely reported. We describe here a case of inadvertent corneal perforation and traumatic cataract that occurred during lid anesthesia in a procedure for hordeolum removal. METHODS: A 33-year-old woman presented with a sudden visual loss of her left eye. She had undergone hordeolum removal the day before at a local clinic. On ophthalmologic examination, the cornea was perforated and the lens cortex was extruded into the anterior chamber. After cataract removal and IOL implantation, antibiotics were injected into the vitreous. RESULTS: Her final visual acuity of the left eye was 20/20. Postoperative specular microscopic examination revealed a normal-range endothelial cell count, coefficient of variation, and hexagonality despite the intracameral lidocaine injection. CONCLUSIONS: Anesthetic injection of an infected lid should be done with great caution. Although there are possibilities of corneal endothelial toxicity and endophthalmitis in case of intracameral lidocaine injection through the infected lid, yet proper management may save the patient's vision without complications.
Lidocaine/administration & dosage ; Lens Implantation, Intraocular ; Lens Capsule, Crystalline/injuries ; Injections/adverse effects ; Humans ; Hordeolum/*surgery ; Follow-Up Studies ; Female ; Eyelids ; Eyelid Diseases/*surgery ; Eye Injuries, Penetrating/diagnosis/*etiology/surgery ; Diagnosis, Differential ; Cornea/injuries ; Cataract Extraction ; Anesthetics, Local/administration & dosage ; Anesthesia, Local/*adverse effects ; Adult