INTRODUCTION

Penetrating eye injuries due to foreign body often cause serious damage to the eyes and vision. In the case of contrast object can be determined by x-rays [1]. In the case of object cannot be determined by x-rays, ultrasound image [2,3], computerized tomography (CT) can be used to confirm [4]. The treatment consists of surgical removal of foreign body, damage recovery and medical treatment of complications such as infection [5,6]. The initial management is removed of foreign intervention as soon as possible to minimize complications. In most of the cases the patient with plant foreign body into orbit to delay in hospital admission cannot be diagnosed by x-ray need to be closely monitored to avoid forgotten foreign body. These are contributing to the success treatment [6-8].

Two cases of plant foreign bodies were reported in this paper.

CASES REPORT

Case 1: RE=Foreign body into orbit through lower lid [8]

Three weeks ago, a 64 year old male patient, farmer, while working to cut eucalyptus trees and suddenly a dry tree twigs snapped and crashed heavily in his right eye. Patients with bleeding in the eye and was taken to an eye specialist for treatment locally. According to the family of the patient, this staff can get here is a very small piece of branch tree (twig) from patient’s eye and medical treatment for more than 2 weeks. During this time the patient's condition did not reduce that tend to increase such as: touching the lower eyelid a tumors with tenderness, pus throught the wound hole intermittent then continuous, visual acuity blured, diplopia relief but patient’s feeling was more uncomfortable. Patient had seeked himself referral to treatment.

Examination: Right eye: Visual acuity 1/10, intraocular pressure 17 mm Hg (Schiotz). Upper lid: normal, lower lids: a bruise wound at the 1/3 corners of the nose lid with a hard tumor, about 2 mm in diameter, pressing against the yellow pus appeared throught the wound hole. The conjunctiva was intact. There was not any traces of foreign bodies in the conjunctiva. Oculomotor: movement somewhat limited and diplopia. The pupil was 3 mm in diameter, round, regular, direct light reflex (+). The anterior chamber and crystalline lens were clear. Fudus examination was normal. Left eye: Visual acuity 3/10, intraocular pressure 17 mm Hg. Oculomotor: normal. The other part of the eye was normal. X-ray: no sign is detected [1]. Ultrasound: A wave showed for strange body, but does not specify the shape, the size of the object [2,3].

Diagnosis: RE= Foreign body into orbit through lower lid caused abscess and diplopia complications.

Treatment: Ciprofloxacin 500 mg × 2/day-combined methylprednisolone 16 mg/day for 1 week.

Surgery: Day 24^th since foreign body into the eye: Local anesthesia and conjunctiva. Surgical exploration by an incision extending hole along the outer wall of the eyeball, in positions 3-4 O’ clock, freeing abscess pus was done. After pus cleaning clearly, strabismus hook was used to detecting foreign body that was located directly beneath the globe, the lower rectus muscle. Then this foreign body was extracted by hook through this hole. From the mouth hole to located foreign object is about 25 mm. Foreign object is a dry twig of tree with size, size: 5 mm diameter, 15 mm length. After surgery a week: abscess collapse, less conjunctival hyperemia, less bruising eyelid, no diplopia. Three weeks after the removal of foreign body the wound was healed. By 3 weeks after treatment right eye completely back to normal, vision 1/10, IOP=17 mm Hg (Figure 1 and the patient's right eye).

Case 2: LE=Foreign body into the orbit through upper lid

Three weeks ago, a 34 year old male patient while working he had fallen and a twig of dry coconut tree had suddenly perforated into the orbit through upper lid of his left eye. The patient visited at the health village station several times with chief complain: the eye lid dropping and difficult to open and an unsealed wound with pus while pressing. Patient was sent to eye doctor after 3 weeks from here. On the eye examinations: Patients with moderate ptosis, lid slit 25 mm - tumor size = 5 mm diameter. Visual acuity RE = 10/10-LE = 10/10 but feel uncomfotable in daily activities because of ptosis. X-ray: no sign is detected [1].

Ultrasound: A wave showed for strange body, but does not specify the shape, the size of the object [2,3].

Diagnosis: LE= Foreign body into orbit throught upper lid caused abscess and moderate ptosis complications.

Treatment: Antibiotics: Ciprofloxacin 500 mg × 2/day combined methylprednisolone 16 mg/day for 1 week [5-7].

Surgery: Local anesthesia eyelid. An incision through the tumor 12 mm was opened and a strabismus hook was used for detecting foreign body. After abscess debridement, a foreign body located at internal rectus muscle and was removed by this hook. The deepth position of foreign body was about 22 mm. Foreign body is a dry branch of coconut with size 5 mm × 10 mm.

One week after surgery: lid slit=4 mm, no diplopia. 2 weeks latter: lid slit=8mm and both eyes open normally (Figure 2 and the patient's left eye).