Impalement Injuries of the Orbit

Etiology: Impalement injuries occur most frequently in situations such as these:

Intraocular foreign body sustained while working with a hammer and chisel.

Fig. 18.8 a The iron splinter is lodged in the lens; the cornea has closed spontaneously immediately after the injury (white arrow). A sphincter injury is also present (black arrow).

Impalement Injury

b The iron splinter entered through the sclera and is now lodged in the retina on the posterior wall of the globe, which it has "coagulated" (white discoloration of the surrounding retinal tissue). Focal burns are placed around the foreign body with an argon laser to fix the retina before a vitrectomy is performed to remove the foreign body.

❖ Children may fall on pencils held in their hands (Fig. 18.9).

❖ Injuries may result from the actions of other persons (such as arrows or darts).

❖ A knife may slip while a butcher is removing a bone from a cut of meat. Often the impaling "stake" will glance off the round hard outer layer of the globe (cornea and sclera) and lodge in the soft tissue of the orbit.

Symptoms and diagnostic considerations: The stake can cause displacement of the globe. Often there will be minimal bleeding in the surrounding

Impalement injury of the right orbit.

Impalement injury of the right orbit.

Fig. 18.9 Orbital injury without injury to the globe following a fall on a pencil held in the patient's hand. (Photograph courtesy of Prof. W. D. Green, M.D., Baltimore, Maryland.)

tissue. Diagnostic studies used to ascertain possible damage to intraocular structures include ophthalmoscopy, radiographic studies, and ultrasound.

Treatment: First aid treatment should leave the stake in situ. Removing the stake could cause severe bleeding and orbital hematoma. If necessary, the stake should be stabilized before the patient is transported to the eye clinic. Once the patient is in the clinic, the foreign body is removed from the orbit and the integrity of the globe is verified, depending on specific findings. Any bleeding is controlled. Prophylactic antibiotic treatment is indicated routinely to minimize the risk of orbital cellulitis.

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