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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 2  |  Issue : 2  |  Page : 560-562

Rubber tree fruit in the eye: A case report of large organic foreign body in orbit


1 Head of Department, Department of Orbit and Oculoplastics, Aravind Eye Hospital and PG Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
2 Medical Officer, Department of orbit and oculoplasty, Aravind Eye Hospital and PG Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
3 Medical Consultant, Department of paediatric ophthalmology, Aravind Eye Hospital and PG Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India

Date of Submission05-Aug-2021
Date of Acceptance25-Sep-2021
Date of Web Publication13-Apr-2022

Correspondence Address:
Velu Maneksha
Aravind Eye Hospital and PG Institute of Ophthalmology, S.N Highroad, Tirunelveli - 627 001, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1990_21

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  Abstract 


Orbital foreign bodies are seen commonly, but the presence of an unusually large organic foreign body in-toto in the orbital cavity is rare. Here, we are discussing a case of the organic orbital foreign body following a fall. A 22-year-old gentleman with a history of fall presented to us with a large organic foreign body in his right orbit with the collapsed globe. Following thorough history and evaluation, the foreign body was removed and the globe was repaired. The eye became phthisical. A custom-fit prosthesis was applied a month after surgery. We are highlighting the importance of surgical intervention and follow-up to achieve good cosmetic outcomes and the importance of protective gear in the workplace.

Keywords: Intraorbital foreign body, ocular prosthesis, ocular trauma, work-related eye injuries


How to cite this article:
Maneksha V, Kavya S, Chakrabarty S. Rubber tree fruit in the eye: A case report of large organic foreign body in orbit. Indian J Ophthalmol Case Rep 2022;2:560-2

How to cite this URL:
Maneksha V, Kavya S, Chakrabarty S. Rubber tree fruit in the eye: A case report of large organic foreign body in orbit. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 May 24];2:560-2. Available from: https://www.ijoreports.in/text.asp?2022/2/2/560/342918



An orbital foreign body is more commonly seen in men (75%–96%) and in a younger age group (15–37 years).[1] The size, location, and type of orbital foreign body determine the structural and functional damage and associated morbidity. Clinical features and outcomes are largely dependent on the type and size of the foreign body. Here, we are presenting a patient with a large orbital foreign body following a fall from a tree while working in a rubber plantation without protective gear. In developing countries like ours, the provision of protective equipment at work is not mandated by concerned authorities. According to various studies, work is a recognized and frequent cause of eye injury, representing 30% to 70% of cases presenting to the ophthalmological emergency departments (OEDs).[2],[3],[4]


  Case Report Top


A 22-year-old gentleman presented to us with a history of fall from a tree of approximately 30 feet in height. He sustained an injury to his face and arm. He was presented to us within a few hours of injury with a large organic foreign body in his right eye.

On examination, his vision in the right eye was no light perception, and that in the left eye was 6/6. On torchlight examination, the right orbit showed a large vegetative foreign body covering the entire orbit [Figure 1]. The rest of the details of the globe was not made out. The anterior and posterior segments of the left eye were normal. Orbital imaging was ordered to assess the extent of damage caused by the foreign body.
Figure 1: Organic orbital foreign body in the right orbit following fall from the tree

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Noncontrast computed tomography (CT) of the orbit with brain screening showed a well-defined radio-dense foreign body with a radiolucent interior of size 46 × 45 mm in the right orbit with three lobes, compressing the globe. There was an associated fracture of the floor of the orbit, the maxillary sinus, and the nasal bone [Figure 2] and [Figure 3]. There was no evidence of intracranial damage.
Figure 2: Axial view of CT scan of orbit showing radiodense foreign body with radiolucent center severely compressing globe into its orbit

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Figure 3: 3D reconstruction of CT scan showing two lobes of three-lobed foreign body fracturing floor of right orbit and roof of the right maxillary sinus. Postoperative image showing standard prosthesis in-situ maintaining contour of the upper and lower lid before custom-fit prosthesis was given

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After explaining nil visual prognosis, written consent was obtained for surgical exploration under general anesthesia. After induction of general anesthesia, under aseptic precautions, the foreign body was removed in-toto. The globe was found to be collapsed. Thorough wound toileting was done. A 360° peritomy was done and a large posterior scleral tear was identified. It was repaired with 9-0 nylon interrupted sutures. The anterior chamber was washed to remove hyphema and was formed with an air bubble. Conjunctiva was closed with 8-0 polyglactin 910 interrupted sutures. Multiple lacerations were found over the upper lid and the medial canthus, which were repaired with 6-0 polyglactin 910 interrupted sutures [Figure 4]. Orbital floor and maxillary bone fractures were managed conservatively. Postoperatively oral antibiotics and NSAIDS were given along with topical antibiotics. The eye was found to be phthisical in the follow-up period. A custom-fit prosthesis was applied 1 month after surgery.
Figure 4: Postoperative image showing standard prosthesis in-situ maintaining contour of the upper and lower lid before custom-fit prosthesis was given

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  Discussion Top


Orbital foreign bodies are divided into organic and inorganic. Organic foreign bodies include wood, vegetative material, and soil, whereas inorganic foreign bodies include glass, plastic, and foam. Inorganic foreign bodies can also be divided into metallic and nonmetallic types.[5]

A large organic foreign body will cause functional and structural morbidity and devastating complications if not treated promptly. A detailed history, thorough examination, and relevant imaging are very crucial to manage a case of orbital foreign body. The symptoms and signs of orbital foreign bodies depend on their size, location, and composition.[1] Surgical intervention is largely guided by the type of foreign body and its location.

Organic foreign bodies have higher rates of sight-threatening complications and infections than nonorganic foreign bodies. They warrant an emergency surgical exploration irrespective of their size and location.[6] But inorganic foreign bodies like glass and metal are well tolerated.

Imaging plays a vital role in diagnosing and managing cases of orbital foreign bodies. CT has a high sensitivity to delineate bone and foreign bodies. A 1–1.5 mm of cut helps in detecting small metallic and nonmetallic foreign bodies. In CT scan, wood shows low attenuation and is difficult to differentiate from air and fat.[7] A bone window will be a better choice for detecting wood than a soft tissue window.[8] On CT, the change in Hounsfield units over time indicates the presence of wood. Magnetic resonance imaging (MRI) is the choice of imaging modality in nonmetallic foreign bodies. However, metallic foreign bodies are an absolute contraindication to MRI.

In our case, CT scan revealed a large trilobed fruit impacting onto the globe with associated orbital wall fractures. The foreign body is found to be a rubber tree fruit with its coverings.

This rubber tree is botanically named Hevea brasiliensis, a flowering plant belonging to the family Euphorbiaceae. The milky latex extracted from the tree is the primary source of natural rubber. These trees grow up to 140 feet. Our patient sustained an injury when he was working in a rubber tree plantation without protective gear. This case highlights the requirement for knowledge on personal protective equipment (PPE) in the working class in developing countries. The employer should provide PPEs to avoid such devastating injuries. Study shows that workers with little job experience and young males between 25 and 34 years of age are under higher risk of exposure to work-related eye injuries.[9]


  Conclusion Top


Large orbital foreign bodies due to work-related injuries are associated with structural and functional morbidities. Recovery of vision may not always be possible but the treating ophthalmologist should aim to provide the maximum cosmesis and ensure proper social rehabilitation.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Finkelstein M, Legmann A, Rubin PA. Projectile metallic foreign bodies in the orbit: A retrospective study of epidemiologic factors, management, and outcomes. Ophthalmology 1997;104:96-103.  Back to cited text no. 1
    
2.
Sahraravand A, Haavisto AK, Holopainen JM, Leivo T. Ocular traumas in working age adults in Finland - Helsinki Ocular Trauma Study. Acta Ophthalmol 2017;95:288-94.  Back to cited text no. 2
    
3.
Cai M, Zhang J. Epidemiological characteristics of work-related ocular trauma in southwest region of China. Int J Environ Res Public Health 2015;12:9864-75.  Back to cited text no. 3
    
4.
Forrest KY, Cali JM. Epidemiology of lifetime work-related eye injuries in the U.S. population associated with one or more lost days of work. Ophthalmic Epidemiol 2009;16:156-62.  Back to cited text no. 4
    
5.
Moretti A, Laus M, Crescenzi D, Croce A. Peri-orbital foreign body: A case report. J Med Case Rep 2012;6:91.  Back to cited text no. 5
    
6.
Lee JA, Lee HY. A case of retained wooden foreign body in orbit. Korean J Ophthalmol 2002;16:114-8.  Back to cited text no. 6
    
7.
Shelsta HN, Bilyk JR, Rubin PA, Penne RB, Carrasco JR. Wooden intraorbital foreign body injuries: Clinical characteristics and outcomes of 23 patients. Ophthalmic Plast Reconstr Surg 2010;26:238-44.  Back to cited text no. 7
    
8.
Singh V, Kaur A, Agrawal S. An unusual intraorbital foreign body. Indian J Ophthalmol 2004;52:64-5.  Back to cited text no. 8
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9.
Serinken M, Turkcuer I, Cetin EN, Yilmaz A, Elicabuk H, Karcioglu O. Causes and characteristics of work-related eye injuries in western Turkey. Indian J Ophthalmol 2013;61:497-501.  Back to cited text no. 9
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