Grease gun injuries to the orbit and adnexa

Grease-gun injury of the orbit: two cases report and literature review

BACKGROUND

The grease-guns injury is an uncommon injury to the orbit. We present the twelfth and thirteenth cases of grease-gun injury to the orbit to be reported in the English language literature since 1964. Here we discus and review the presentation, investigation, and treatment of this unusual trauma.

CASE PRESENTATION

Case 1 was a 29-year-old man who presented 1 day after a grease-gun injury of the left orbit with severe pain, marked periorbital swelling, and proptosis. Computed tomography (CT) revealed penetration of grease into his left orbit. Following surgical removal, proptosis decreased. The limitation of extraocular movement and loss of visual acuity to finger count was discovered after the initial surgery. Motility gradually returned. Visual acuity recovered after phacoemulsification, capsular tension ring and intraocular lens implantation for traumatic cataract and subluxation. Case 2 was a 6-year-old boy who was referred 2 months after a grease-gun injury for worsening swelling with sinus, necrosis and slight ptosis of the upper left eyelids. This is a case of orbital chronic inflammation from grease-gun injuries masquerading as orbital cellulitis. The imaging findings of CT and magnetic resonance imaging (MRI) are not typical. Surgical exploration and debridement was inevitable and actually relieved the symptoms.

CONCLUSIONS

Grease-gun injuries can damage the orbit in different degrees. Careful history inquiry and taking is important to establish the diagnosis. Imaging examinations using CT or MRI are helpful to determine depth of trauma and foreign bodies in the orbit at diagnosis. We suggest that surgical exploration and debridement is a key step in the management.

Diagnostic uncertainty following orbital injury from a grease gun

Orbital trauma involving high-pressure grease guns is rare and can cause significant morbidity due to retained intraorbital grease. Grease can appear similar to intraorbital air on cross-sectional imaging, and clinicians should have a high index of suspicion for retained intraorbital grease and know how to recognise this. In this case, we will share the clinical and radiological findings as well as management of retained intraorbital grease.

Idiopathic Lipogranulomatous Orbital Inflammation: A Case Report and Literature Review

A 57-year old woman presented with a 6-month history of a left red eye associated with diplopia. Examination was remarkable for 2 mm left-sided axial proptosis and restriction on left upgaze and abduction associated with diplopia. She had no previous history of trauma or surgery to the face. Magnetic resonance imaging revealed an enhancing infiltrative mass in the left intraconal space. Biopsy of the anterior orbital fat revealed extensive lipogranulomatous inflammation with no abnormalities noted on flow cytometry, culture, or special stains. The patient was managed with a tapering course of oral prednisolone and two 40 mg intraorbital triamcinolone injections resulting in complete resolution of her presenting symptoms. This represents a rare case of idiopathic lipogranulomatous orbital inflammation.

Grease gun injury of the orbit: A rare case report

We report a case of intraconal grease gun injury along with traumatic optic neuropathy in a 20-year-old male. He presented with dimness of vision and proptosis of the left eye (LE) following an accidental injury at work place. The computer tomography of orbit revealed hypodense grease orbit. Cream colored grease was continually exuding from the conjunctival wound. Patient improved rapidly after the surgical removal of the grease by anterior orbitotomy. Grease gun injuries to the orbit have rarely been reported. The present case is the eighth report throughout the world, and the first in India as per our knowledge.

A rare case of orbital granulomatous inflammation from explosive hydraulic oil masquerading as orbital cellulitis

The differential diagnosis for acute orbital inflammation is broad. We report a case of granulomatous orbital inflammation due to high-pressure oil injury to the orbit presenting as an atypical orbital cellulitis. Here we review the presentation and treatment of orbital inflammation from oil.

Under pressure: progressively enlarging facial mass following high-pressure paint injection injury

High-pressure paint injection injuries are relatively rare industrial accidents and almost exclusively occur on the non-dominant hand. A rarely documented complication of these injuries is the formation of a foreign body granuloma. We report a case of a 33-year-old man presenting with extensive facial scarring and progressive right paranasal swelling 7 years after a high-pressure paint injury. After imaging investigations, an excision of the mass and revision of scarring was performed. Access to the mass was gained indirectly through existing scarring over the nose to ensure an aesthetic result. Histological analysis revealed a florid granulomatous foreign body reaction to retained paint. To the best of our knowledge, this is the first reported case of a facial high-pressure paint injury with consequent formation of a foreign body granuloma.

Diesel fuel injury to the orbit

A 48-year-old man was seen in the Wills Eye Institute emergency room for pain and decreased vision after having a diesel engine fuel cylinder explosion in his face. Clinical examination showed proptosis, decreased extraocular motility, and increased intraocular pressure; CT scan imaging revealed hypodense areas within the orbit. His orbital signs rapidly worsened despite aggressive antibiotics, steroids, and surgical intervention. Two orbitotomies revealed diesel fuel infiltration of the intraconal and extraconal spaces that proved impossible to evacuate completely. The patient ended up losing vision from an intense chemical cellulitis with subsequent orbital compartment syndrome and optic neuropathy. This case highlights the severity of orbital chemical injuries and their variable prognoses despite aggressive management.

Subconjunctival latex paint from occupational injury

BACKGROUND

Accidental eye trauma with spray guns are rare, but potentially very serious, injuries. Although it is agreed that these injuries require immediate and vigorous therapy, the specifics of such therapy are poorly defined. With latex paint sprayer injuries to hands and extremities, resulting chemical-induced inflammation, high-pressure necrosis, ischemic necrosis, and gangrene require surgical debridement and possibly, amputation. With eye injuries, treatment is directed at preservation of vision, as there is a potential risk of visual loss.

OBJECTIVE

There is currently no consensus on optimal treatment of ocular spray paint injuries. Here we propose a management approach to ocular spray paint injuries with a successful outcome in the case reported.

CASE REPORT

We report the first case, to our knowledge, of an industrial airless spray gun injury that resulted in subconjunctival deposition of latex paint in a soft contact lens wearer. Vision was preserved with medical management consisting of irrigation and topical corticosteroids, antibiotics and cycloplegics.

CONCLUSION

Although latex paint spray gun injuries to the eye are not encountered frequently in practice, this case shows that conservative medical management with no surgical intervention is effective for ocular injuries with preserved vision.

Traumatic optic neuropathy accompanying orbital grease gun injury

We report a case of traumatic optic neuropathy accompanying a grease gun injury to the orbit. A 48-year-old man with a grease gun injury visited our clinic with decreased visual acuity, proptosis and limited extraocular movement (EOM). Orbital CT revealed a crescent mass of fat in the medial intraconal space. The grease was exuded from a lacerated conjunctival wound. The visual evoked potential (VEP) test demonstrated a decreased response in the left eye. Proptosis and EOM were improved after surgical removal of the grease. Systemic high-dose corticosteroid therapy was administered for suspected traumatic optic neuropathy, after which VEP nearly recovered, while visual acuity was slightly improved. A second surgery for traumatic cataract did not further improve visual acuity.

Delayed presentation of grease-gun injury to the orbit

A 44-year-old man was examined for marked edema and ptosis of the right upper eyelid after grease from high-pressure hydraulic machinery penetrated his right orbit 20 days earlier. The diagnosis of residual grease in the injured orbit was confirmed by CT and MRI, and the clinical presentation. During orbital exploration, the grease was removed completely. Among the wide variety of orbital foreign bodies, grease is rarely reported. We present the sixth case of grease-gun injury to the orbit to be reported in the English language literature since 1964.

Intraconal grease-gun injury: a therapeutic dilemma

The case of a 31-year-old man with an accidental grease-gun injury to his left orbital region is presented. CT and MRI showed a well-delineated intraconal cyst in the superior aspect of the left orbit surrounded by a significant inflammatory response. The patient was followed for 11 months. Diplopia was not reported at any time, and visual acuity, visual fields, and all other examinations remained normal. Uneventful surgical removal was performed at the patient's request. Histopathologic examination demonstrated a typical picture of lipogranulomatous inflammation. In a review of the accessible literature, only four cases of intraorbital grease-gun injuries were detected; all of them submitted to early surgical removal. We conclude, however, that an intraconal oil/grease cyst can be carefully monitored and--in the absence of symptoms--must not necessarily be removed.

Penetrating grease gun injury in the face

We present the case of a sailor who sustained a penetrating grease gun injury to his face, and the challenging subsequent series of events.

Pneumonitis following grease gun injury

Grease gun trauma often involves subcutaneous injection of the grease because of the high pressures required for its industrial application. The case is presented of a man who developed a pneumonitis shortly after sustaining a grease gun injury, with injection of grease into his upper thigh associated with significant vascular damage. Pneumonitis has not previously been reported with this type of injury, and is likely to represent a systemic reaction to the local inflammatory response. Management of these injuries should incorporate early debridement with anticipation of underlying vascular trauma, and also an awareness of the potential systemic complications.

High-pressure grease injury of the face

We describe a rare case of high-pressure grease injury of the face in a 48-year-old man with severe facial edema, soft palate swelling, and bleeding from the nose and mouth. Preoperative computed tomography (CT) revealed multiple low-density areas in nasal cavity, subcutaneous tissue of the cheek, soft palate, right maxillary sinus, and right infratemporal fossa. The patient complained of a dyspnea feeling, and immediate tracheostomy was performed. The grease was removed by the Caldwell-Luc incision approach but was partially left in the infratemporal fossa. After the operation, the patient still complained cheek and temporal pain. CT and magnetic resonance imaging were useful to diagnose the remaining grease, and the remnant of the grease was completely removed by the Weber-Fergusson incision approach.

High-pressure paint gun injury to the orbit and ocular adnexa

High-pressure injection injury to the orbit and adnexa is a rare but potentially blinding type of trauma. Few cases of such injury have been reported in the literature. A 27-year-old Indian man accidentally injected paint material from a high-pressure nozzle gun into his left eye. Radiological investigation revealed the presence of paint material in the orbital tissues and the ethmoidal sinuses. The patient underwent two orbital surgeries to remove the paint material. He later developed signs suggestive of limbal stem cell failure and was treated with limbal stem cell autografting. He also has ophthalmoplegia with a compensatory anomalous head posture that was managed conservatively. We report the clinical course and outcome of this unfortunate patient to highlight the complexity of such an injury and the need for a multidisciplinary approach in its management.

Fatal and non-fatal injuries from vessels under air pressure in construction

Using a surveillance system that captures data on construction workers treated in an urban emergency department, we identified a series of injuries caused by vessels and tools under air pressure. We describe those six cases, as well as similar cases found in the Census of Fatal Occupational Injuries; we also review data from the National Surveillance for Traumatic Occupational Fatalities database and data from the Bureau of Labor Statistics. Among the injuries and deaths for which we had good case descriptions, the majority would have been prevented by adherence to existing Occupational Safety and Health Administration standards in the construction industry.