Case of penetrating orbitocranial injury caused by wood

An apparently trivial injury of the eyelid may be associated with injury in the orbit (bony cavity containing the eye) and possibly penetrating injury to the brain. A case is presented of a 41-year-old man who fell from a fence into some wooden foliage. Two small wood splinters were removed from his lower right eyelid. Additionally he suffered cuts on his skin and conjunctiva (mucous membrane lining the eyelids and anterior surface of the eyeball), and had downward displacement of the eyeball, with limited eye movements. His cuts were stitched up and he was admitted to the eye unit of the hospital. Six hours later he developed a fever and his consciousness deteriorated. A hematoma (blood blister) of the outer covering of the brain was suspected. Computed tomographic scan revealed bleeding within the brain. A hole made in the skull revealed bruised brain cortex with hemorrhage. The man improved with antibiotic treatment, but then vision in his right eye deteriorated. Emergency surgery was performed, which revealed an abscess cavity containing wood fragments within the right frontal lobe of the brain, as well as in portions of the orbit. At most recent follow-up that patient had full eye movements but no vision in the right eye; there were no other neurological problems. In this case failure to recognize the extent of the injury resulted in abscess formation within the brain and blindness in one eye. Brain penetration by wood is unusual. Wood is not detected by X-ray, and is difficult to identify on computed tomography. Recently magnetic resonance imaging has been reported helpful in identifying intraorbital wood. (Consumer Summary produced by Reliance Medical Information, Inc.)