Diagnosis and management of orbital inflammation and infections secondary to foreign bodies: a clinical review

Orbital inflammation and secondary infections may be caused by many types of foreign bodies, including organic and inorganic matter, non-autogenous surgical implants and allografts, and surgical hardware and materials utilized in reconstructive surgery. In penetrating injury patients, the nature of the foreign body determines the clinical behavior; inert objects such as steel and glass may not cause significant inflammation to warrant their removal. Removal of organic foreign bodies, however, is mandatory since these objects usually lead to secondary infection with abscess and fistula formation. This paper reviews salient points related to history-taking and physical examination, diagnostic workup, and medical and surgical treatment in foreign body-induced orbital inflammation and infections. It is emphasized that practically every case of orbital trauma should be approached with a high index of suspicion for penetrating injury with possible intraorbital foreign body. The investigational tools to detect orbital foreign bodies, including ultrasonography, computed tomography and magnetic resonance imaging, are reviewed. The principles of the management, including antimicrobial therapy, surgical indications and techniques, are also discussed.