Penetrating wound of the orbit: a 31-year follow-up

SUMmARY The case is described of a man who at the age of 17 suffered accidental penetration of his right orbit by a rod and spring from a machine gun. Operation was successful, and follow-up 31 years later showed normal vision at 20/20 in both eyes. Penetrating wounds of the orbit may cause considerable damage, resulting in the following complications: rupture of the eyeball with expulsion of the intraocular contents; retinal separation, immediate or delayed; avulsion of the optic nerve, with permanent blindness; ocular muscle injury of such severity as to cause permanent diplopia, lachrymal gland injury as well as extensive fractures of the oibital walls into the sinus cavities or into the cranial cavity, with leakage of the cerebrospinal fluid, a threat to life. Penetrating orbitocranial injuries are a grave threat to the patient's survival, with 12 % mortality among 42 cases of orbitocranial wounds during the second world war (Webster and Guardjian, 1943). Serious infections may be intro-duced, with resulting meningitis, intracranial haemorrhage, and cavernous sinus thrombosis resulting in a fatal outcome. On the other hand gross injuries may cause astonishingly little damage and often leave the eyeball intact along with other vital structures. Many bizarre injuries have been reported (Duke-Elder, 1954) wherein various foreign bodies of different sizes, shapes, and edges pass through the orbit without damaging any important structures. Un-eventful recoveiy may follow without functional impairment. A successful outcome of these injuries depends on the following important factors: the path of the penetrating object, the size of the object, the space the object takes in a constricted area, the time factor (from the time of injury to the time of medical and surgical care), the extent of the surgical intervention, the elimination of all possible compli-cations, and the routes of antibiotic therapy to prevent or control secondary infection. A careful examination of the anterior and posterior ocula