A Rare Penetrating Trauma of Both Orbit and Nasal Cavity

Document Type : Case Report


Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.


Diagnosis of orbital foreign body (FB) penetration is usually obvious when part of the FB is still attached at the entry wound (1). However, the depth and course of the FB in this case was not visible.
Case Report:
A 5-year old female presented with a pencil penetrating the left orbit. A computed tomography (CT) scan showed that the pencil penetrated the left orbit (extraseptal) through the lacrimal bone to the left nasal cavity, then perforated the nasal septum, crossing the right nasal cavity. Finally, the pencil penetrated the lamina paperatea to the right orbit and stopped near the right optic nerve. The pencil was gently removed under general anesthesia with close observation of the eyes.
A case of a pencil penetrating both orbits and nasal cavities was reported, and the pencil was safely removed. This draws attention to the possible penetration power of a pencil, with the possibility of injury to the orbit and optic nerve on the opposite side of the penetration. It also demonstrates the feasibility of safe removal.


Main Subjects

1. Turbin RE, Maxwell DN, Langer PD, Frohman L, Hubbi B, Wolansky L, et al. Patterns of transorbital intracranial injury: a review and comparison of occult and non-occult cases. Surv Ophthalmol 2006; 51:449–60.
2. Gazzaz M, Lmejjati M, Akhaddar A, Derraz S, Aghzadi, El Khamlechi A. Paediatric penetrating orbitocranial injury with a pencil-a report of two cases. Pan Arab J Neurosurg 2000;4:2.
3. Bulbuliaa A, Rouxb P, Asholic A, Bulbuliad N. An unusual case of a penetrating wound of the orbit. South African Optometrist 2006;65:75–77.
4. Long J, Tann T. Orbital trauma. Ophthamol Clin North Am 2002;15:249–53.
5. Al-Otaibi F, Baeesa S. Occult orbitocranial penetrating pencil injury in a child. Case Rep Surg 2012; 2012:716791.
6. Tenenholz T, Baxter AB1, McKhann GM. Orbital assault with a pencil: evaluating vascular injury. AJR Am J Roentgenol. 1999:173:144.