Needlefish-related orbital foreign body – two illustrative cases and literature review

We present two cases of needlefish beak penetration to the orbit and cavernous sinus and a literature review of all 12 published cases involving needlefish orbital injuries. Our first case is a 7‑year‑old boy with a needlefish penetrating orbital injury where the beak was embedded in the orbit and cavernous sinus for 3 months prior to partial surgical removal. The second case is a 20‑year‑old man with a needlefish beak penetrating the orbit and cavernous sinus of his only seeing eye which was completely removed with retention of vision. There are 12 reported cases of needlefish orbital injuries with varying ophthalmic and neurological injury, including death. In three cases, needlefish beak material was left within the orbit to be managed conservatively. Needlefish penetrating orbital injuries are rare and can result in significant morbidity and vision loss. These partly ossified cartilaginous foreign bodies may be conservatively managed, especially if chronic.