Orbitocranial wooden foreign body retrieved by transcranial and superior orbitotomy

We did a transcranial superior orbitotomy to retrieve a wooden foreign body from the right eye of a 49-year-old man who had fallen six feet and landed in a bush. His Glasgow coma scale on arrival at the emergency department of a district hospital was 14/15 (E3, V5, M6) and he was otherwise stable. The ophthalmology service noted a 1.5cm puncture wound in his right upper eyelid. Ocular examination showed a dense, relatively afferent pupillary defect and no perception of light in the right eye. Initial imaging with computed tomography (CT) did not clearly show a foreign body, but magnetic resonance imaging (MRI) at the tertiary centre showed a 3cm organic foreign body that had traversed inferolaterally to the optic canal, passed through the superior orbital fissure, and extended into the temporal lobe (Fig.

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