Penetrating retro-orbital foreign body – large glass shards: A maxillofacial surgery case report

OBJECTIVES This case report looks at a 53-year-old patient who had suffered a penetrating foreign body injury to the retro-orbital space and the surgical approach taken to remove the large glass fragments found and to correct the damage caused. Having fallen while holding a drinking glass, this patient suffered multiple laceration injuries to the maxillofacial region upon the glass shattering in contact with the face. However, unbeknownst to the patient, several glass fragments became embedded in the retro-orbital space, and this was only detected on presentation 2 days post-injury with unusual symptoms of sharp, sudden pain elicited on extreme gaze as well as ocular motility restriction. METHODS This embedded foreign body required a creative surgical approach to remove it involving gaining access to the retro-orbital space via a superior approach and cautiously following the path the glass shards took upon entry, all the way to the posterior aspect of superior rectus. Intra-operative radiographic guidance was required due to the restriction of operating within this space and particularly when removing glass fragments distal to superior rectus. RESULTS AND CONCLUSION The patient recovered well and experienced an immediate improvement in ocular motility with a return to relative normality over the next few months.