Man with loss of vision and blocked nose found to have 9cm foreign body in nasal cavity

BMJ Case Reports authors have described their treatment of a patient in his 20s who was found to have a large wooden foreign body traversing from his left nasal cavity to his right orbit.

As well as the wooden fragment, which was more than 9cm in length, the patient was found to have a further two wooden foreign bodies retained in the naso-orbital complex.

The patient told clinicians at the All India Institute of Medical Science in Delhi that he had been involved in a traffic accident 10 days previously. A local hospital had sutured a wound at the side of his left nostril.

Since the accident, he had a sudden loss of vision in his right eye as well as bilateral nasal obstruction.

Examination by the clinicians revealed a healed scar to the left of the patient’s nostril. He had no measurable visual acuity in his right eye.

CT and MRI scans revealed a linear foreign body extending from below the nostril through the nasal cavity, the right orbit and entering the cranial cavity.

The wooden fragment was removed through surgery under general anaesthesia, with the patient receiving intravenous broad-spectrum antibiotics and oral antifungal therapy due to the high risk of infection attached to an organic foreign body.

As well as the wooden fragment that was initially identified on the scans, the surgical teams also identified and removed two more wooden fragments extending into the nasopharynx.

The case report authors highlighted that because of the prolonged retention of the foreign body before treatment “irreversible optic nerve damage had likely occurred.”

While ptosis of the right eye improved, the patient’s level of vision remained the same as before the operation.