Periocular Skin 'Tattooing' Caused by Neutral Pen Pigment Mistaken for Periorbital Bruising: A Case of Missed Diagnosis of Traumatic Intraorbital Pen Core Foreign Body

Abstract

Abstract Background When an eye trauma occurs, orbital foreign bodies are widespread. The most common types of foreign bodies are metal, followed by plant foreign bodies, while oil foreign bodies are rare. Here, we report a case of misdiagnosis of periorbital bruising caused by the tip of a blue gel pen core. It can easily be misinterpreted as subcutaneous congestion since it causes the skin to become blue, which can result in the orbital foreign bodies being ignored.Case presentation The child was stabbed by a gel pen at the upper eyelid of his left eye while playing, resulting in a skin tear under the eyebrow arch, and the surrounding skin was cyan. Because the wound was small and closed smoothly, only local cleaning and disinfection were given without suturing. Within one month after injury, the cyanosis of the skin did not subside, which was considered by the doctors as subcutaneous congestion after injury.Conclusions Our report for the blue gel pen orbital foreign bodies can provide some reference for the diagnosis and treatment experience. The reason for the missed diagnosis in this case was that the blue color of the skin in the wound area was mistaken for "bruise". Orbital foreign body impact injury must be thoroughly found all foreign body fragments, if can not be found should be highly suspected foreign body into the body. The wound tract of ocular trauma may be concealed. If conditions permit, it is recommended to perform imaging examination to avoid omission of foreign bodies.