ABSTRACT
Intraorbital foreign bodies are frequently the result of high-velocity injuries with varying clinical presentations. The resultant diagnosis, management, and outcome depend on the type of foreign body present, anatomical location, tissue disruption, and symptomatology. A patient who presented to the Emergency Department with a large intraorbital foreign body projectile that was not evident clinically, but found incidentally on computed tomography and subsequent plain films is reported. The emergency room physician needs to be aware of the differential diagnosis of a unilateral irregular pupil with or without visual acuity changes. The differential diagnosis for any trauma patient with an irregular pupil with significant visual loss must include intraorbital foreign body and associated injury to the optic nerve directly or via orbital compartment syndrome secondary to hemorrhage and/or edema. Patients with significantly decreased visual acuity may benefit from emergent surgical intervention. In patients with intact visual acuity, the patient must be monitored closely for any visual changes as this may require emergent surgical intervention.
ABSTRACT
Isolated bilateral abducens palsy is a rare event, especially in the setting of closed head injury. Cases that lack radiographic or pathologic findings to explain the etiology of the palsy are limited to case reports. Injury mechanisms have been postulated, but a consensus does not exist. The authors describe a case of traumatic isolated bilateral abducens palsy lacking radiographic and pathologic findings. A previously unreported potential pathophysiologic injury mechanism is theorized based upon anatomical structure and mode of injury.
