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FERRAZ LCB, SCHELLINI SA, ET AL. 8. Solomon AW, Zondervan M, Kuper H, Buchan JC, Mabey DC, Foster A. Trachoma control: a guide for programme managers. Geneva: World Health Organization; 2005. 9. Schellini SA, Lavezzo MM, Ferraz LB, Olrich Neto J, Medina NH, Padovani CR. Prevalência e localização espacial dos casos de tracoma detectados em escolares de Botucatu, São Paulo - Brasil. Arq Bras Oftalmol [Internet]. 2010 [citado 2010 Out 10];73(4):358-62. Disponível em: http://www.scielo.br/pdf/abo/v73n4/v73n4a12.pdf 10. Medina NH, Gentil RM, Caraça M, Suzuki CK, Melles HH. Análise de exames de imunofluorescência direta para o diagnóstico de tracoma. Rev Saúde Pública. 1996; 30(2):135-40. 11. Barros OM, Luna EA, Medina NH, Gentil RM. Manual de controle do tracoma. Brasília: Ministério da Saúde, Fundação Nacional da Saúde; 2001. 12. Thein J, Zhao P, Liu H, Xu J, Jha H, Miao Y, et al. Does clinical diagnosis indicate ocular chlamydial infection in areas with a low prevalence of trachoma? Ophthalmic Epidemiol. 2002;9(4):263-9. 13. Caligaris LS, Morimoto WT, Medina NH, Waldman EA. Trachoma prevalence and risk factors among preschool children in a central area of the city of São Paulo, Brazil. Ophthalmic Epidemiol. 2006;13(6):365-70. 14. Cruz AA, Medina NH, Ibrahim MM, Souza RM, Gomes UA, Goncalves GF. Prevalence of trachoma in a population of the upper Rio Negro basin and risk factors for active disease. Ophthalmic Epidemiol. 2008;15(4):272-8. 15. Alves AP, Medina NH, Cruz AA. Trachoma and ethnic diversity in the upper Rio Negro Basin of Amazonas State, Brazil. Ophthalmic Epidemiol. 2002;9(1):29-34. 16. Lombardi HF. Oportunidades de diagnóstico precoce do HIV em gestantes do município de Bauru [dissertação]. Botucatu: Faculdade de Medicina, Universidade Estadual Paulista; 2002. 17. D’Amaral RKK, Cardoso MRA, Medina NH, Cunha ICKO, Waldman EA. Fatores associados ao tracoma em área hipoendêmica da Região Sudeste, Brasil. Cad Saúde Pública [Internet]. 2005 [citado 2008 Out 12];21(6):1701-8. Disponível em: http:// www.scielosp.org/pdf/csp/v21n6/07.pdf XXXVI Congresso Brasileiro de Oftalmologia 5 a 8 de setembro de 2011 Centro de Convenções da FIERGS Porto Alegre - RS Informações: CCM Eventos Tels.: (51) 3086-9115 E-mail: contato@ccmeventos.com.br Ste: www.cbo2011.com.br Arq Bras Oftalmol. 2010;73(5):433-7 437
ARTIGOS ORIGINAIS | ORIGINAL ARTICLES Impacted foreign bodies in orbital region: review of nine cases Corpo estranho impactado na região orbital: revisão de nove casos THIAGO DE SANTANA SANTOS 1 , AUREMIR ROCHA MELO 1 , HÉCIO HENRIQUE ARAÚJO DE MORAES 1 , PAULO ALMEIDA JÚNIOR 2 , EDWALDO DOURADO 1 ABSTRACT Orbital injuries with a foreign body may result in severe structural and functional damage to the eye or orbital contents. Management and prognosis depend on the composition and location of the foreign body and whether there is secondary infection. Metallic objects and glass are the most frequently encountered and well-tolerated, whereas organic foreign bodies can elicit an inflammatory reaction and lead to serious complications. Despite the modern imaging methods, it is often difficult to identify and locate organic intraorbital foreign bodies. This paper presents a review of nine cases of impacted foreign bodies in the orbital region and discusses the diagnosis and treatment of this kind of injury. The following data were collected: age, gender, etiology of injury, occurrence of fracture, anatomical location of fracture, type of object, signs and symptoms, type of imaging exam used, approach, transoperative complication and occurrence of death. Foreign body injuries in the orbital region can be treated with a combination of clinical suspicion, basic knowledge and diagnostic tests and depend on the skill and experience of the surgeon, thereby decreasing the surgical risk of iatrogenic injury in relation to the inherent risk of retaining an organic intraorbital foreign body. Keywords: Orbital fractures; Eye foreign bodies; Maxillofacial injuries/surgery; Case reports; Human; Male; Adult RESUMO A apresentação clínica do corpo estranho orbitário é variável. Traumatismos orbitários com um corpo estranho podem provocar danos estruturais e funcionais graves para os olhos ou o conteúdo orbital. O tratamento e o prognóstico dependem da composição, localização e presença ou não infecção secundária. Objetos metálicos e de vidro são os mais frequentes e bem tolerados, enquanto corpos estranhos orgânicos podem provocar reação inflamatória que leva a sérias complicações. É frequentemente difícil identificar e localizar corpos estranhos orgânicos intraorbitais, apesar de modernos métodos de exames de imagens. Com vista a ilustrar e discutir o diagnóstico e tratamento deste tipo de lesão, este estudo apresenta uma revisão de nove casos de corpos estranhos impactados na região orbital. Os seguintes dados foram coletados: idade, sexo, etiologia, ocorrência de fratura, localização anatômica da fratura, tipo de objeto, sinais e sintomas, tipo de exame de imagem utilizado, abordagem, complicação trans-operatória e a ocorrência de morte. Ferimentos provocados por corpos estranhos na região orbital podem ser tratados pela combinação da suspeita clínica, testes de conhecimentos básicos de diagnóstico, habilidade e experiência do cirurgião. A soma de tais fatores leva à redução do risco de iatrogenia em relação ao risco inerente de retenção intraorbitária de corpo estranho orgânico. Descritores: Fraturas orbitárias; Corpos estranhos no olho; Traumatismos maxilofaciais/cirurgia; Relatos de casos; Humanos; Masculino; Adulto INTRODUCTION Orbital injuries with a foreign body may result in severe structural and functional damage to the eye or orbital contents. Amaurosis, fulminant orbital phlegmon leading to enucleation and orbital fracture with possible brain injury and meningitis have been reported following accidents with wooden intraorbital particles (1-4) . A metallic foreign body in the intraocular region may be associated to a rare condition known as ocular siderosis, which is clinically characterized by heterochromia, mydriasis, pigmentation of the structures of the anterior chamber, an increase in intraocular pressure, etc (5-6) . The clinical presentation of an orbital foreign body is variable. Management and prognosis depend on the composition and location of the object and whether there is secondary infection. Metallic objects and glass are the most frequently encountered and well-tolerated, whereas organic foreign bodies can elicit an inflammatory reaction and lead to serious complications. Despite modern imaging methods, it is Work carried out at Hospital da Restauração em Recife. 1 Physician, Faculdade de Odontologia de Pernambuco - FOP - Recife (PE), Brazil. 2 Physician, Universidade Tiradentes - UNIT - Aracajú (SE), Brazil. Correspondence address: Edwaldo Dourado. Faculdade de Odontologia de Pernambuco/Universidade de Pernambuco. Av. General Newton Cavalcanti, 1.650 - Camaragibe (PE) - CEP 54753-220 - E-mail: thiago.ctbmf@yahoo.com.br Recebido para publicação em 13.03.2010 Última versão recebida em 12.07.2010 Aprovação em 15.10.2010 often difficult to identify and locate organic intraorbital foreign bodies (7) . A wooden intraorbital foreign body is usually difficult to detect through conventional diagnostic methods (8-9) . When such a body is not detected during an initial ophthalmological exam, it may be retained for a long time until it is recognized through some ocular symptom or through plain x-rays, computed tomography (CT) or echography. Some authors reported two cases of suspected intraorbital wooden foreign bodies using CT scans, in both of which magnetic resonance imaging (MRI) clearly showed a well-delineated, low-intensity, intraorbital injury (8) . Unlike small foreign bodies, which are generally located completely within the orbit, large impacted objects in the orbital region cause severe visual impact and require specialized care within as short a period of time as possible (9) . The approach to this kind of injury should be sequential and multidisciplinary, beginning with the trauma unit, which provides maintenance of the airways and hemodynamic stabilization, followed by neurological, ophthalmologic and vascular evaluation (10-11) . This paper presents a review of nine cases of impacted foreign bodies in the orbital region and discusses the diagnosis and treatment of this kind of injury. METHODS Nine patients consecutively treated at the Oral and Maxillofacial Surgery Department of a public hospital in the city 438 Arq Bras Oftalmol. 2010;73(5):438-42
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