Abstract Listings 2024

Purpose

To review the presentations and management of intraorbital wooden foreign bodies (IOWFB) and provide guidance on prompt diagnosis and treatment strategies.

Methods

We conducted a retrospective review of IOWFB patients treated between 2018 and 2024 at a tertiary care centre. Data on symptom onset, clinical presentation, imaging, surgeries, microbial cultures, complications, and outcomes were collected and analysed.

Results

Nine patients were included in the study. Symptom onset ranged from immediate to one year post-injury, with only one patient aware of the foreign body. Most cases presented with infections, except for one patient who presented with a chronic mass. Imaging findings varied from air to hyperdensities. Intracranial or sinus penetration occurred in five cases. Four cases required multiple attempts for complete removal. In six cases, complete removal was achieved by a multidisciplinary team via craniotomy (five cases) and transnasal endoscopy (one case), either initially (two cases) or as salvage procedures (four cases). Incomplete removals at the initial attempt were from wound exploration (three cases) and anterior orbitotomy (one case). Infections led to complications such as intraorbital or intracranial abscesses and meningitis. Poor visual outcomes were noted in patients with initial visual acuity at or below the finger-counting level. Bacterial and fungal growth was present in the majority of patients, indicating a very high risk of infection.

Conclusion

Clinicians should maintain a high suspicion of IOWFB due to frequently ambiguous histories. A meticulous review of imaging is pivotal in prompt diagnosis. The high risk of incomplete removal necessitates carefully designed surgical approaches, especially through multidisciplinary teamwork. Empirical antifungal treatment, alongside antibiotics, may be essential due to the significant risk of infections from both types of organisms.

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