Intraocular foreign bodies iofbs are rather variable in presentation, outcome, and prognosis. Once an intraorbital foreign body is diagnosed, appropriate management includes culture of the wound or foreign body if removed and administration of antibiotics. Intraorbital wood detection by magnetic resonance imaging beth f. Superficial foreign body multiple linear epithelial defects suggests foreign body beneath the eyelid be sure to flip upper eyelid with cottontip can be removed if superficial with moist cottontip if embedded can be removed with cottontip or 25gauge needle however would consult ophthalmologist prior to removal. Intraorbital wooden foreign body, diagnosed by nmr and ultrasonography, and extirpation by cranioorbital approach. We present mri and diagnostic imaging of a metallic intraocular foreign body in a young patient with no known history of trauma or reason for the existence of. Detection and characterization of intraorbital foreign bodies ifb is fundamental in acute trauma setting, preventing inflammatory sequelae or complications related to ifb movements when a mri study is planned. Metallic intraocular foreign body as detected by magnetic resonance.
Download the edinburgh imaging academy 2019 flyer 265. An iofb may get introduced into the eye by a freak accident such as a highvelocity gunshot or a mishap at the work place. Mri systems are expensive to buy and run so are currently beyond most dghs. A n intraorbital foreign body iofb is defined as an object located inside the bony orbital walls, posterior to the orbital septum but outside the ocular globe 10,38.
It is aimed at beginners in possession of only a minimal level of technical expertise, yet it introduces aspects of mr that are typically considered technically challenging. Intraorbital foreign body projectile as a consideration. With increased awareness and advanced surgical techniques, the outcome and the prognosis for these potentially devastating injuries have substantially improved. So a metallic foreign body located deep in the posterior orbit may be only observed and given appropriate supportive care, thus. Introduction to magnetic resonance imaging techniques. Management of intraorbital foreign bodies ophthalmic pearls trauma i ntraorbital foreign bodies orbfbs are a common complication of ocular trauma. These are better seen with magnetic resonance imaging mri. Screening for intraorbital metallic foreign bodies prior to mri. To grasp the idea of the mri process, it is important. The issue of intraorbital foreign bodies is an interdisciplinary. In a patient with a surgicallyimplanted foreign body, mri becomes more challenging but remains highly useful in evaluating for complications 25, 26, 27 despite its ability to provide excellent contrast resolution, mri can be hindered by artifact secondary to metallic implants, screws, staples and metallic shavings.
In the past, there have been various reports on the use of ultrasound, xrays, ct and mri to find foreign bodies that could not be identified by a clinical examination. Ct, cbct, mri and us in detecting different sizes of foreignbodies. An absolute contraindication to mri is the presence of a metallic foreign body in the globe. Department of plastic reconstructive and aesthetic surgery, trakya university faculty of medicine, edirne. In addition, fast spinecho allows shorter scan time than standard conventionalspinecho. Mri allows for visualization and precise identification of foreign bodies, which is vital for surgery. Intraorbital foreign body request pdf researchgate. A patient who presented to the emergency department with a large intraorbital foreign body. Any external object that gets embedded inside the orbit is referred to as an intraorbital foreign body iofb. Role of bscan ultrasonography in the localization of. Penetrating orbitocranial injuries caused by intraorbital foreign body are a rare cause of morbidity being most common among young people.
However, an mri is contraindicated if the suspected foreign body is ferromagnetic. Intraocular foreign bodies iofbs are foreign bodies that have penetrated the eye and are lodged within the globe. Intraorbital fat has high signal on the proton density and t2weighted fast spinecho images and therefore serves as a good background to delineate hypointense wooden foreign bodies. Intraorbital wooden foreign body mimicking air at ct. Intra orbital foreign body iofb reporting for radiographers. When an intraorbital foreign body is suspected, it is important for the management of the patient that. The accurate localization of intraocular foreign bodies iofbs is very important for the management of ocular trauma patients. The other 24 patients had metallic foreign bodies adjacent to or within the globe and were thought to be at risk for movement of the metallic foreign body as a result of mr imaging. The university of queenslands institutional repository, uq espace, aims to create global visibility and accessibility of uqs scholarly research.
Intraorbital metallic foreign bodies can be well tolerated and may not require surgical intervention despite. The name nmr imaging was changed to magnetic resonance imaging in part because the term nuclear has an unpleasant connotation in some circles. Ct findings in 2 patients with a wooden foreign body in the orbital region soft tissue, and a series of ct measurements of wooden elements are. In this case there was extreme concern on the initial mri imaging it was immediately terminated on seeing this artefact, but fortunately ct showed the metal to be outside the globe and the patient suffered no illeffects. Request pdf screening for intraorbital metallic foreign bodies prior to mri. Intraorbital foreign body detection and localisation by. A total of 1593 patients who had identified themselves as being at risk for an intraorbital metallic foreign body had undergone plain radiography or ct of the orbits. To emphasise the need for careful selection of mri andor usg along with ct scan when investigating for an intraorbital foreign body, especially of the ferrous nature. Ferromagnetic foreign bodies are a clear contraindication for magnetic resonance imaging due to the high magnetic field within the scanner. Pdf detection of intraorbital foreign material using mdct. Management of intraorbital foreign bodies american. A rare case of a glass foreign body in the parapharyngeal. Diagnostic imaging in ophthalmology pp 9398 cite as.
Whilst the underlying phenomenon is simple, in the sense that many mri scanners were found to have the capability of performing fmri studies once the technique had been. The massachusetts eye and ear infirmary illustrated manual. The resultant diagnosis, management, and outcome depend on the type of foreign body present, anatomical location, tissue disruption, and symptomatology. Siedlecki, 1 edmundtsui, 2,3 jiedeng, 1 anddonaldm. Detection of intraorbital foreign material using mdct. Intraocular foreign body iofb, a kind of ophthalmic emergency, accounts for about 6 % of the ocular trauma and is commonly seen in young male 1. Longterm retention of an intraorbital metallic foreign. Magnetic resonance imaging mri is a method of sectional assessment that provides excellent differentiation of many tissues types in different areas of the body with the advantage of using nonionizing radiation. They report a case of mr imaging of an intraorbital where the eyeball is situated bullet, showing that mr actually allows highresolution.
Case presentation a 41yearold male patient presented with a complaint of swelling on the left upper eyelid since 5 months with no ocular complaints. Essentials of body mri extensively covers the sector, offering clear and detailed steering on mri as a helpful software for the primary evaluation and disadvantage fixing of sicknesses of the body, along with the abdomen, liver, pancreas, pelvis, coronary coronary heart. The term refers to a foreign body that occurs within the orbit but outside the globe. Plain film, ct and mri sensibility in the evaluation of intraorbital foreign bodies in an in vitro model of the orbit and in pig eyes. Pdf intraorbital wooden foreign body, diagnosed by nmr. Sedation or anesthesia is often necessary in pediatrics when magnetic resonance imaging is performed.
Functional mri wellcome trust centre for neuroimaging. The massachusetts eye and ear infirmary illustrated manual of ophthalmology is the musthave medical reference book for the everchanging field of ophthalmology. Of crucial importance are also ct and mri scans, which help determine foreign body location and its topographic relationships with neighboring structures e. Radiographer, intra orbital foreign body, jackknife freeresponse receiver. Introduction the purpose of this study was to run a preliminary investigation to establish if a short course of learning would increase radiographers performance in intraorbital foreign body iofb detection and localisation on premagnetic resonance imaging mri orbital computed radiographs cr. Optic atrophy induced by an intraorbital wooden foreign body. We report the case of an asymptomatic 47 yearold male patient who suffered a penetrating wound from a metallic foreign body that became embedded adjacent to the optic nerve for over thirty years, as well as the associated examination, imaging, and fundus photography. An intraorbital injury from an occult wooden foreign body. Radiation dose and image quality optimisation in medical imaging. Bmode ultrasound revealed medium amplitude echoes through out the vitreous with attached retina. The term intraorbital foreign body refers to a foreign body that occurs within the orbit but outside the ocular. The frequency of retained surgical foreign material is one per 1,0001,500 laparotomies rappaport, 1990. Optic atrophy induced by an intraorbital wooden foreign. Glass trauma caused by traffic accidents is often seen in the head and neck region.
Slices must be sufficient to cover the whole brain. Itraorbital organic foreign body radiological methods in diagnosis. The foreign bodies not only cause mechanical damage but also bring pathogenic microorganisms into the eyes, leading to endophthalmitis, which seriously affects the prognosis of visual acuity. Case report longterm retention of an intraorbital metallic foreign body adjacent to the optic nerve andrewn.
Mri stimulates a signal from the object using magnetic fields and radiofrequency pulses mri reads data using magnetic gradients and places it into kspace frequency domain kspace frequency domain is translated into spatial domain giving an image. Papers concerning plain film and ct sensibility in ifb detection show controversial results. Basics of mri professor sir michael brady frs freng department of engineering science oxford university. Miller 4 geisel school of medicine at dartmouth, hanover, nh, usa. Intraorbital wooden foreign body on mri 2 years after injury. We use cookies to offer you a better experience, personalize content, tailor advertising, provide social media features, and better understand the use of our services. Clinical presentation, radiological appearance and management article pdf available in sultan qaboos university medical journal 81. Standard textbooks do not describe the ct spectrum of wooden foreign bodies. Intra orbital wooden foreign bodies can be difficult to detect. Culture an intraocular foreign body iofb or a sample of vitreous if an infection is suspected. Radiographic studies and ct may fail to identify their presence.
This text serves as an introduction to magnetic resonance imaging techniques. In contrast, orbfbs are lodged within the walls of the. An unexpected ferromagnetic foreign body detected during. A three plane localiser must be taken in the beginning to localise and plan the sequences. Intraorbital foreign bodies are frequently the result of highvelocity injuries with varying clinical presentations. The prevalence of intraorbital metallic foreign bodies in our study population was low 0. Intraorbital definition of intraorbital by medical.
Investigation of a case of suspected wooden foreign body in the orbit should include an mri scan if there is no contraindication, and no foreign body has been. Intraorbital foreign body detection and localisation by radiographers. Retained intraorbital metallic foreign bodies are welltolerated and does not cause much impact on visual deterioration, thus they should be managed conservatively in the absence of specific indications for removal. A study on the ability of panoramic, ct, conebeam ct, mri and. The comparative accuracy of radiolucent foreign body detection using ultrasonography. The foreignbodies were then implanted into a sheeps head in the infraorbital part. Trauma cases that apparently seem minor with no visibly protruding. Ophthalmic neuroimaging findings in iih reflect the mechanical deformations of the optic nerve sheath, lamina cribrosa, and posterior sclera due to increased csf pressure transferred through the intraorbital optic nerve, and these findings are generally reported based on subjective radiologic interpretations in studies 18,22,23. Bscan ultrasonography is usually used to detect iofbs in the posterior segment. A n intraorbital foreign body is an important cause of ocular morbidity especially in the peadiatric and adolescent age groups. This anesthesia outside of the operation room combines specific requirements and risks. Delivered by an experienced teaching team and accredited by the college of radiographers, cpd continuing professional development now scheme, this intra orbital foreign body iofb reporting study day aims to enhance imaging service provision by equipping you with the skills required to interpret orbital xrays as part of the mri screening process. Treatment depends on the nature and location of the injury in the eye. Here, we report three cases with iofbs in the anterior segment near the posterior lens capsule, which were accurately localized by bscan ultrasonography.
For this reason we investigated plain film, ct and mri. Unusual intraorbital foreign body pubmed central pmc. Metallic orbital foreign body on mri radiology case. Intraorbital foreign bodies orbfbs are a common complication of ocular trauma. It is essential for medical diagnosis and has evolved very quickly, providing valuable advances in clinical practice12. The cotton matrix of the sponge forms the nidus of the foreign body reaction. Mri orbits planning indications for mri orbits scan mri. Retained intraorbital wooden foreign bodies may lead to complications such as prolonged suppuration with a draining fistula, foreign body granuloma, orbital cellulitis, abscess formation, panophthalmitis, extraocular muscle damage, exophthalmos and even brain abscesses 4,5.