Visual Recovery after Penetrating Injury Through the Orbit

Abstract

Background: Penetrating trauma through the orbit cavity by blunt edged instrument could bring destructionto many organs located in it. This article is aimed to report a case of severe penetrating injury throughthe orbit cavity with a good visual recovery after surgical treatment.

Case Illustration: A 29-year-old male came to Cicendo National Eye Hospital with a complaint ofbloody eye. His head was hit by fallen wall from behind while he was working using crowbar thatcaused the tip of crowbar penetrated into intracranial cavity through the right orbit cavity. Vital signswere within normal limit, with the crowbar fixated on 2 mm below the margin of inferior orbital edge.Visual acuity was 2/60 (bed side examination) without any RAPD. CT-scan showed the tip of crowbarentered cranial cavity. Patient was diagnosed with penetrating injury through the orbit and referred toNeurosurgery Department. Operation was done under general anesthesia and it was found that the tipripped of duramater on frontal region and both inferior rectus and inferior oblique muscle were rippedoff. We decided to leave the eye and give methyl prednisolone iv 1 g a day. Post operative examinationshowed that the visual acuity was 20/60 and patient was unable to move the right eye downward.Patient did not complain of double vision on primary position.

Conclusion: Penetrating injury could be devastating for many organs inside the orbit. With a carefulexamination and correct management, vision can be saved.

Keywords: penetrating injury, orbital cavity

Background: Penetrating trauma through the orbit cavity by blunt edged instrument could bring destruction
to many organs located in it. This article is aimed to report a case of severe penetrating injury through
the orbit cavity with a good visual recovery after surgical treatment.
Case Illustration: A 29-year-old male came to Cicendo National Eye Hospital with a complaint of
bloody eye. His head was hit by fallen wall from behind while he was working using crowbar that
caused the tip of crowbar penetrated into intracranial cavity through the right orbit cavity. Vital signs
were within normal limit, with the crowbar fixated on 2 mm below the margin of inferior orbital edge.
Visual acuity was 2/60 (bed side examination) without any RAPD. CT-scan showed the tip of crowbar
entered cranial cavity. Patient was diagnosed with penetrating injury through the orbit and referred to
Neurosurgery Department. Operation was done under general anesthesia and it was found that the tip
ripped of duramater on frontal region and both inferior rectus and inferior oblique muscle were ripped
off. We decided to leave the eye and give methyl prednisolone iv 1 g a day. Post operative examination
showed that the visual acuity was 20/60 and patient was unable to move the right eye downward.
Patient did not complain of double vision on primary position.
Conclusion: Penetrating injury could be devastating for many organs inside the orbit. With a careful
examination and correct management, vision can be saved.
Keywords: penetrating injury, orbital cavity
rauma pada wajah merupakan masalah
sosial serta masalah kesehatan
masyarakat disebabkan karena frekuensi
serta besaran masalah yang ditimbulkan, serta
keterkaitan dengan kecelakaan lalu lintas,
tindak kejahatan, serta kaitannya dengan
rasa tidak aman. Bola mata meski hanya
meliputi 0,27% dari seluruh permukaan tubuh,
dan merupakan 4% dari seluruh permukaan
wajah, mata merupakan bagian tubuh ketiga
yang paling terekspose oleh trauma.1,2 Kehilangan
penglihatan pada satu atau kedua
mata merupakan