Eyelid and Orbital Injury due to High-Speed Rotating Dental Bur
Author: Hueyjong Shih
Base Hospital / Institution: Massachusetts Eye and Ear, Boston, Massachusetts, United States of America
ePoster presentation
Abstract ID: 25-364
Purpose
This case highlights an unusual eyelid and orbital injury due to a high-speed dental bur.
Methods
Case report and review of the literature.
Results
A 71-year-old woman sustained an eyelid injury during a dental implant placement. The high-speed rotating bur slipped, rolled up her face, and lacerated through her right lower eyelid. Examination revealed a complex lid laceration through her right lower eyelid margin, with the retained drill bit entangled within the eyelid soft tissue and orbital fat. Visual acuity in the affected eye was 20/30, with normal intraocular pressure. Ocular motility was intact and there was no relative afferent pupillary defect or signs of globe injury. The bur tip was removed at bedside by excising the entangled soft tissue, primarily orbital fat, with Westcott scissors. Computed tomography of the orbits with intravenous contrast confirmed no retained radiopaque foreign bodies. Intraoperatively, a 3 cm right lower eyelid laceration was identified—full thickness laterally and partial-thickness medially. The conjunctiva was also lacerated, and the septum was violated with exposure of orbital fat. Right lower eyelid marginal and non-marginal laceration repairs were performed.
The patient tolerated the procedure well. At post-operative day 11, visual acuity improved to 20/25. The wound healed well, with good eversion and mild lower lid retraction, likely secondary to the extensive lid injury.
Conclusion
As this case demonstrates, orbital trauma from dental instruments, though rare, is a preventable yet potentially serious complication of dental procedures involving high-speed rotary tools. Only three prior cases have been reported, each requiring surgical intervention for embedded metallic foreign bodies, and in two cases the patients were not wearing eye protection. Given the significant risk to vision and the ocular adnexa, and consistent with safety recommendations for the use of all high-powered drills, the routine, mandatory use of protective eyewear for both providers and patients should be universally adopted for all dental procedures involving powered instrumentation.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Carolina A. | Chiou | Alpert Medical School of Brown University, Providence, Rhode Island, United States of America |
| Lisa Y. | Lin | Massachusetts Eye and Ear, Boston, Massachusetts, United States of America |
