A humongous intraorbital foreign body in a possessed patient.docVIP

 PAGE \* MERGEFORMAT 9 A humongous intraorbital foreign body in a possessed patient Of: Kok Foo Lee, Siti Raihan Ismail1, Adil Hussein1, Mohtar Ibrahim1, Hasanah Che Ismail, Win Mar @ Salmah Jalaluddin [Abstract] A 39 years old gentleman presented with red painful right eye. He had self inflicted an injury to his right eye with a wooden stick and he saw a vision of an old man indicating him to do so. Clinically, the right eye was moderately proptosed, complete ophthalmoplegia and the periorbital skin was severely swollen. Imaging showed right orbital cellulitis with inferior ophthalmic vein thrombosis, bilateral cavernous sinus syndrome and impending cavernous sinus thrombosis. No intraorbital or intraocular foreign body was reported. Despite aggressive intraven ous antimicrobials, the patient s condition was not improved. Exploration done under anesthesia exposed a huge wooden stick at the inferior fornix. Patient showed a remarkable recovery after the removal of the foreign body and intensive antibiotics therapy. A diagnostic challenge may occur in psychiatry patient that a possibility of self inflicted injury. A detail history, examination and appropriate investigations are mandatory to reveal the underlying etiology. A high index of suspicion and correlated clinical findings with imaging studies are the most helpful guide in managing intraorbital foreign body and orbital cellulitis. Prompt diagnosis and treatment could potentially prevent further serious morbidity or mortality. [Keywords:] wooden intraorbital foreign body, orbital cellulitis, self inflicted injury, psychiatric patient INTRODUCTION Intraorbital foreign body (IOFB) is a rare phenomenon involving accidental and non accidental presence of foreign body in the eye globe. Many case reports have been published from around the world, frequently reporting bizarre manners in which the IOFB were introduced into the eye globe. There were many previous reports of wooden IOFB [1,2]. Most o