A 23-YEAR-OLD man had a 1-month history of painless, slowly progressive
swelling above his right eye. External examination revealed mild ptosis and
inferior globe displacement (Figure 1A).
The patient denied recent or remote trauma.
Ultrasound examination revealed a superior orbital mass with low internal
reflectivity. On computed tomographic scan the mass measured 1.6 × 2.8
cm (Figure 1B). Biopsy demonstrated
areas of chronic granulomatous inflammation and foreign body fragments (Figure 2). The presence of large cell walls
(Figure 2B) suggested plant material.
Scanning electron photomicrographs were forwarded to a forensic botanist (S.C.).
The identification of dicotyledon libriform fibers and a dicotyledon vessel
wall indicated that the foreign bodies were hardwood fragments. Sharp, regular
edges were consistent with published scanning electron photomicroscopic characteristics
of mechanically cut wood (Figure 3).
This suggested both a possible origin of the hardwood fragments and etiology
of the occult injury (eg, particles flung from a power saw or wood chipper).1,2
Mayo GL, Long LS, Fitzsimmons T, Scribbick FW, Carlquist S. Delayed Orbital Foreign Body Reaction to Dicotyledon (Hardwood) Libriform Fibers. Arch Ophthalmol. 2002;120(12):1770–1771. doi:10.1001/archopht.120.12.1770
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