Impalement Injuries of the Orbit

Impalement Injuries of the Orbit

Etiology:

Impalement injuries occur most frequently in situations such asthese:

❖ Children may fall on pencils held in their hands (Fig. 18.9).

❖ Injuries may result from the actions of other persons (such as arrows or darts).

❖A knife may slip while a butcher is removing a bone from a cut of meat. Often the impaling “stake” will glance off the round hard outer layer of the globe (cornea and sclera) and lodge in the soft tissue of the orbit.

Symptoms and diagnostic considerations:

The stake can cause displace-ment of the globe. Often there will be minimal bleeding in the surrounding tissue. Diagnostic studies used to ascertain possible damage to intraocular structures include ophthalmoscopy, radiographic studies, and ultrasound.

Treatment:

First aid treatment should leave the stakein situ. Removing thestake could cause severe bleeding and orbital hematoma. If necessary, the stake should be stabilized before the patient is transported to the eye clinic. Once the patient is in the clinic, the foreign body is removed from the orbit and the integrity of the globe is verified, depending on specific findings. Any bleeding is controlled. Prophylactic antibiotic treatment is indicated routinely to minimize the risk of orbital cellulitis.