Case report: Orbital trauma mimicking globe rupture: A case of preserved vision

This case report describes a 38-year-old male who presented with significant orbital trauma following an injury by a wooden object. Despite a concerning CT scan suggesting right globe rupture, surgical exploration revealed an extraconal foreign body with an intact globe. This report highlights the importance of a thorough clinical examination and careful surgical exploration in managing complex orbital trauma.
Introduction: Orbital trauma can involve a variety of injuries, including fractures, lacerations, and foreign bodies. Prompt diagnosis and management are crucial to prevent vision loss and other complications. This case report presents a unique presentation of orbital trauma with a positive outcome.
Case Presentation: A 38-year-old male presented to MKCG Medical College, Berhampur, India, with a history of trauma to the right eye by a wooden object. Examination revealed an extensive laceration involving the eyebrow, eyelid, and periorbital ecchymosis with subconjunctival hemorrhage. A wooden foreign body was visible within the right orbit. Visual acuity was not assessed initially.
Investigations: A CT scan demonstrated a radiolucent foreign body in the medial aspect of the right extraconal region along with a right globe rupture. Additionally, fractures of the floor, medial wall, and lamina papyracea of the right orbit were identified, along with bilateral maxillary hemosinusitis. B-scan ultrasonography revealed an attached retina and anechoic vitreous.
Treatment: Considering the CT scan findings, surgery was undertaken under local anesthesia. The wooden foreign body was successfully removed from the right extraconal space, and the eyelid laceration was repaired. Post-operatively, the patient received broad-spectrum antibiotics, analgesics, corticosteroids, and topical ophthalmic medications with a steroid taper.
Outcome: At 10 days post-surgery (POD-10), the patient's best-corrected visual acuity (BCVA) was 6/9, indicating significant vision preservation. The steroid medication was tapered, and the patient recovered without complications such as restricted ocular motility (RAPD), extraocular muscle injury (EOM), retinal detachment, or vitreous hemorrhage.
Discussion: This case presented a diagnostic challenge due to the CT scan suggesting a ruptured globe. The patient had a severe injury and a concerned CT scan report showing right globe rupture. Fortunately, despite this on OT table patient’s injury was completely extraconal with an intact right eyeball and his vision was preserved after the surgery, a remarkable outcome. ENT surgeon was called due to maxillary hemosinus as per the CT report but luckily, there was no bleeding during the surgery, as was highly probably. Furthermore, during the recovery, there were no complications like RAPD, EOM injury, retinal detachment, or vitreous hemorrhage, which was also a miraculous positive outcome.
Conclusion: This case report demonstrates the potential for a positive outcome in complex orbital trauma with a globe-sparing approach. A comprehensive clinical examination and surgical exploration are crucial for optimal patient management.

Keywords: Orbital trauma, globe rupture, foreign body, extraconal, case report.