The orbital trauma caused by diesel explosion may be initially innocuous2. Clinically, it presents with a slightly bloated tissue with mild skin laceration, which can be easily overlooked. Diesel has liposoluble compounds which are toxic and liposoluble to human tissue, resulting in rapid necrotic progression of the traumatic lesion4. In the present case, hypodensity bubbles seen on orbit CT were assumed to air at first, however, after consideration of the history and damaged eyelid, we postulated that the bubbles may indicate a diesel fluid. A second orbital CT scan showed that the bubbles had decreased which suggested that the diesel had pervaded and dissolved into the soft tissues, causing cellulitis. This triggered intraorbital hypertension and even orbital compartment syndrome which collectively contributed to the subdermal necrosis. Although we performed debridement on the patient eyelid on day 3, the necrosis of skin and subdermal soft tissue continued, thereby early timing of debridement is beneficiary for the prognosis.
Similar cases toxic cellulitis associated with diesel have been reported. Bae et al reported chemical orbital injury due to diesel explosion, the swelling eyelid worsened 12 hours after the laceration suturing, the wound swab culture revealed staphylococcus epidermidis. The patient underwent 3 rounds of pus drainage and a transplantation of the skin necrosis to retained a structured eyelid2. Rabinowitz et al presented a case which developed toxic orbital cellulitis 10 hours after the suturing of eyelid laceration caused by a diesel engine explosion. Debridement and the wound drainage was performed. The patient recovered with a good result of eyelid but his vision was no light perception at last3. Irawati et al reported a case of blunt trauma from diesel explosion appeared with a harmless laceration on the upper eyelid, which developed ptosis and limited superior eye movement1.
Diesel-related toxic orbital cellulitis is destructive and has rapidly progression. When a diesel-related orbital cellulitis is susceptible, CT scan should be applied to evaluate the orbital condition. Intravenous third generation cephalosporins together with topical antibiotics were recommended5. General application of steroids should be started at diagnosis, Holds et al claimed high dosage of steroids at the beginning if severe inflammation occurred. Most cases need surgical debridement and orbital decompression, some propose observation on the patient if no obvious evidence was found for inflammation6. The vision prognosis depends on the chemical toxicity and the damage of optic nerve. In summary, for patient with diesel-associated orbital trauma, a thorough and timely debridement as well as removing of residual diesel is necessary for the patient’s prognosis.