An unusual case of total ophthalmoplegia.
An eight-year-old male child presented with drooping of the left eyelid with a history of penetrating injury of hard palate by an iron spoon seven days ago, which had already been removed by the neurosurgeon as the computed tomography scan revealed a spoon in the left posterior ethmoid and sphenoid bone penetrating into the middle cranial fossa. On examination, visual acuity was 20/20 in each eye and left eye showed total ophthalmoplegia. Oral cavity revealed a hole in the left lateral part of the hard palate. We managed the case with tapering dose of systemic prednisolone. The total ophthalmoplegia was markedly improved in one month. Cases of foreign bodies in the orbit with intracranial extension are not unusual, but the path this foreign body traveled through the hard palate without affecting the optic nerve, internal carotid artery or cavernous sinus makes an interesting variation.
Chowdhury
Ravindra Kumar
RK
J.P.M. Rotary Eye Hospital & Research Institute, C.D.A. Sector-6, Bidanasi, Cuttack - 753014, India. ravisbp@rediffmail.com
Gupta
Navnit
N
Padhy
Krishna Charan
KC
D002648:Child; D003937:Diagnosis, Differential; D004305:Dose-Response Relationship, Drug; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D008297:Male; D009886:Ophthalmoplegia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D021362:Palate, Hard / Q000293:injuries*; D011239:Prednisolone / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed; D014950:Wounds, Penetrating / Q000150:complications* / Q000175:diagnosis
D005938:Glucocorticoids; D011239:Prednisolone
Orbit. 2008;27(3):187-9
18569826
Ann Plast Surg. 2004 Jul;53(1):60-4
15211201
J Fr Ophtalmol. 2001 Mar;24(3):295-302
11285447
Indian J Ophthalmol. 1995 Dec;43(4):195-6
8655199
Trans Am Ophthalmol Soc. 1931;29:75-90
16692920
Indian J Ophthalmol. 1993 Jul;41(2):86-7
8262611