A missed case of a large occult intraorbital branch foreign body caused by tree branch laceration: case report.

PURPOSE: This study aimed to report a rare case of a large occult intraorbital branch foreign body initially misdiagnosed as orbital cellulitis and conjunctival contusion, and to summarize clinical experience to improve the diagnosis and prognosis of similar cases.

METHODS

A retrospective case report following the CARE guidelines, detailing the clinical manifestations, diagnostic process, surgical intervention, and follow-up outcomes of a 60-year-old male patient with a large occult intraorbital branch foreign body.

RESULTS

A 60-year-old male presented with right ocular swelling and pain for 2 days after a tree branch laceration and was initially diagnosed with right orbital cellulitis and conjunctival contusion. Symptoms did not improve after conventional anti-infective treatment. Orbital magnetic resonance imaging (MRI) revealed a linear abnormal signal in the right medial rectus muscle, consistent with an intraorbital foreign body (highly suggestive of a tree branch) with multiple surrounding infectious foci. Emergency surgery was performed to remove a 2 cm branch foreign body, combined with debridement, drainage, and standardized post-operative anti-infective and anti-inflammatory therapy. Visual acuity gradually recovered: right eye visual acuity improved to 0.5 at discharge and 0.8 at the 1-month follow-up. At the 2-month follow-up, diplopia had resolved completely, and the right eye showed full extraocular motility without limitation.

CONCLUSION

For patients with ocular trauma caused by vegetative foreign bodies, clinicians should maintain a high suspicion for intraorbital foreign bodies, perform detailed history taking and comprehensive physical examinations, and perform orbital MRI in a timely manner to avoid misdiagnosis and missed diagnosis. Computed tomography is the primary screening modality for orbital trauma, while MRI is the preferred examination for suspected vegetative intraorbital foreign bodies. Early surgical removal of the foreign body combined with standardized anti-infective treatment is crucial for improving prognosis and reducing severe complications.