Air in the Orbit: Could it be a Wooden Intraorbital Foreign Body?

Background: We are reporting this case to reitrate the importance of maintaining high index of suspicion for wooden intraorbital foreign bodies in cases of intraorbital inflammation or infection. The case highlights the value of providing adequate clinical details when requesting radiological investigations and to carefully interpret investigations against the clinical scenario. Case Presentation: A young patient presented with features of worsening orbital cellulitis following a fall over a bush. Initial assessment suspected posterior ruptured globe and a request was sent electronically for Computerized Tomography of brain and orbit for right eye trauma. The Computarized Tomography showed translucent area in medial orbit, which was interpreted as air, and an indented globe. The initial exploration showed only bits of vegetative matter and an intact globe. Due to worsening orbital cellulitis in the following twenty four hours, the case was discussed with the radiologist with possibility of wooden intraorbital foreign body. A Magnetic Resonance Imaging scan of brain and orbit was performed which revealed four centimetre wooden foreign body indenting the globe medially. The surgical technique was planned accordingly. The wooden foreign body was successfully removed.. The patient subsequently fully recovered following completing the antibiotic course. Conclusion: This case highlights the importance of including a wooden foreign body in the differential diagnosis in cases of worsening orbital infection and inflammation. A high index of suspicion at presentation should especially be maintained in trauma cases to avoid delay to diagnosis. Liaising with the radiologist is crucial to obtain best quality imaging in order to guide management.