Intraorbital foreign body: Weighing factors for care

Reviewed by H.B. Harold Lee, MD

Detection and management of an intraorbital foreign body in patients who have sustained orbital trauma can differ depending on the material involved and its location, according to H.B. Harold Lee, MD, private practice, Oculofacial Plastic and Orbital Surgery, Indianapolis, IN. The decision on whether to remove the object is based on assessment of the benefits and the risk.

As a general rule, Dr. Lee said that he tries to remove any intraorbital foreign body when he believes the procedure can be done safely and successfully based on the location of the object.

“I try to remove any intraorbital foreign body if it is anteriorly located,” he said. “I also try to remove a vegetative foreign body even if it is posteriorly located because of the increased risk of infection with vegetative material. Unless there is a good indication for removal, however, I will usually leave a posteriorly located metallic foreign body.”

Metallic foreign bodies

A BB gun pellet is the most common type of metallic intraorbital foreign body seen in the United States, accounting for up to three-fourths of such cases. Typically, the pellets used in the United States are made of steel and zinc, and do not pose a risk of lead poisoning if left in situ.

“Removing shotgun shell is more reasonable in theory because these shells contain a significant amount of lead,” Dr. Lee said. “However, in a search of the literature, I could not find any reported cases of lead poisoning from a retained intraorbital or intracranial foreign body.”