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Photo Essay
December 2002

Delayed Orbital Foreign Body Reaction to Dicotyledon (Hardwood) Libriform Fibers

Arch Ophthalmol. 2002;120(12):1770-1771. doi:10.1001/archopht.120.12.1770

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

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