2017-18 HSC Section 3 Green Book

Figure 1. A 53-year-old woman with right superior eyelid and eyebrow avulsion with a rose bush branch (white arrow) and pooled clear fluid noted in the wound.

Figure 3. A endoscopic view of ethmoid roof with the foreign body (FB) in situ and multiple eyebrow hairs (white arrow) noted in the field.

Figure 2. (A–C) A noncontrast computed tomography of the orbits axial (A) plane, with straight lucency representing a foreign body (FB) penetrating the medial orbit, lamina papyracea, and ethmoids. (B) Coronal plane shows displacement of fovea ethmoidalis superiorly and medially (yellow arrow), with adjacent round lucency representing FB. (C) Sagittal plane, showing displacement of ethmoid roof intracranially (yellow arrow), with underlying lucency of the FB. intact globe were retracted, and the FB was removed under endo- scopic visualization (Fig. 4). Numerous fragments were removed, both endoscopically and transorbitally, including branch frag- ments and eyebrow hair. The specimens were sent for cultures and pathology. The fractured ethmoid roof was reduced and a standard cerebrospinal leak (CSF) repair was performed endoscopically by using Duragen (Integra, Plainsboro, NJ), an abdominal fat graft, and Tisseel (Baxter, Deerfield, IL). The eyelid laceration was partly closed, and a Penrose drain was placed. After surgery, the patient did well, with intact vision. Cul- tures were positive for coagulase negative Staphylococcus and Paraco- niothyrium species fungus. The lumbar drain was removed on post- operative day 7. The patient completed courses of voriconazole for 4 weeks and vancomycin and/or ceftazidime for 2 weeks. The patient was last seen 5 months after surgery, with no neurologic or ophthal- mologic sequelae. (Fig. 5).

Figure 4. An ~ 4.8-cm rose bush branch after removal from the right eye.

Figure 5. A schematic of the systematic review of 215 publications.

METHODS Institutional review board exemption was determined for the case report and systematic review. A detailed title and abstract search of MEDLINE (NCBI, Bethesda, MD) and Embase (Elsevier, Amsterdam,

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