Central Retinal Vessel Occlusion Secondary to Intraorbital Foreign Body Related Cellulitis - A Case Report

1. Szu-Yuan Lin¹
2. Hao-Lin Su¹
3. I-Hua Wang¹
4. Jieh-Ren Jou²

¹Cathy General Hospital, Taipei, Taiwan
²National Taiwan University Hospital, Taipei, Taiwan

Purpose: To report a case of central retinal vessel occlusion secondary to intraorbital foreign body related cellulitis

Method: Case report

Results: A 59-year-old male had progressive painful blurry vision & eyelid swelling. He was poked by an unknown plant on his right eye one day prior to his presentation. On initial ophthalmic evaluation, visual acuity in the right eye was 20/40. Eyelid erythema with local heat, proptosis, severe conjunctival chemosis and ophthalmoplegia were noted in the right eye. Fundus showed subretinal hemorrhage. Computed tomography (CT) revealed abnormal soft tissue opacity with air pocket at medial aspect of right orbit extraconally and abnormal soft tissue density over right maxillary and ethmoid sinus. The diagnosis of right orbital cellulitis was made and emergent orbital decompression surgery was performed. During operation, an organic foreign body was found in peri-orbital space. Bacterial culture showed Klebsiella oxytoca & Streptococcus pneumoniae which were susceptible to ampicillin and sulbactam. But his vision still deteriorated after operation. Combined occlusion of the central retinal artery and vein was diagnosed. It is postulated that orbital compartment syndrome caused mechanical compression of the central retinal vessels leading to the vascular occlusions.

Conclusion: Intraorbital foreign body was possible in patient with trauma history even no perforation wound detected initially. Organic foreign body could be missed by CT scan. Despite emergent decompression, orbital compartment syndrome may result in severe visual loss.