title: Changes in management strategies after spontaneous migration of a retained intraorbital metallic foreign body.
abstract: OBJECTIVE
  Because of the controversial biologic tolerance and management, retained intraorbital metallic foreign body (RIMFb) poses a formidable challenge to surgeons. Besides location of the foreign body, indications for surgical management include neurologic injury, mechanical restriction of the eye movement, and development of local infection or draining fistula. The authors describe an unusual case of spontaneous migration of a RIMFb.
  
  
  METHODS
  A 26-year-old man had a gunshot injury on the left orbit. The patient was initially managed conservatively because of the posterior position of the bullet fragment. Thereafter, because of the clinical impairments and anterior migration of projectile, surgical treatment was considered.
  
  
  RESULTS
  Spontaneous anterior migration has led to mechanical disturbances and inflammatory complications that comprise explicit surgical indications for removal. The patient underwent surgery with complete relief of symptoms. We suppose that extrinsic ocular muscles might play a role in shifting large RIMFb over time, leading to change in the management strategies.
  
  
  CONCLUSIONS
  Spontaneous migration of RIMFb is a rare clinical situation that can lead to pain, local deformity, as well as changes in the management strategies of the affected patients even in the late phase of follow-up.
authors.affiliation: Department of Surgical Specialties, Division of Neurosurgery, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Plínio Duarte
authors.initials: PD
authors.lastname: Mendes
authors.forename: Edgar Garcete
authors.initials: EG
authors.lastname: Fariña
authors.forename: Guilherme Brasileiro
authors.initials: GB
authors.lastname: de Aguiar
authors.forename: Carlos
authors.initials: C
authors.lastname: Telles
authors.forename: Marcus André
authors.initials: MA
authors.lastname: Acioly
mesh_terms: D000328:Adult; D005129:Eye Foreign Bodies / Q000601:surgery*; D005548:Foreign-Body Migration / Q000601:surgery*; D006801:Humans; D008297:Male; D008670:Metals; D009915:Orbit / Q000293:injuries* / Q000601:surgery*; D014948:Wounds, Gunshot / Q000601:surgery*
chemical_list: D008670:Metals