Toxic Orbital Cellulitis and Optic Neuropathy from High-Pressure Diesel Fuel Injury: A Case Report and Literature Review.

Purpose: High-pressure injuries to the orbit are rare, yet they can cause severe damage due to mechanical destruction and the toxicity of the injected substance. Diesel fuel toxicity can lead to rapid necrosis and inflammation, complicating the prognosis even with prompt medical intervention.

Methods: A 39-year-old male presented with a right orbital injury from a diesel fuel explosion. Initial symptoms included mild periorbital swelling and a laceration on the upper eyelid. Despite early management with antibiotics and surgical repair, the patient's condition rapidly deteriorated, developing severe periorbital swelling, pain, and decreased vision. Multiple surgical debridements were performed to remove necrotic tissue and residual diesel fuel. Aggressive treatment with broad-spectrum antibiotics and corticosteroids was administered.

Results: Despite the aggressive treatment, the patient's vision deteriorated to no light perception, indicative of optic neuropathy. Over the following days, the patient showed significant improvement and was eventually discharged with ongoing antibiotic therapy. At a 6-month follow-up, the patient had good cosmetic outcomes despite mild limitations in eye movement.

Conclusion: High-pressure orbital injuries, especially those involving toxic substances like diesel fuel, require early and aggressive management. A multidisciplinary approach, including prompt surgical intervention, broad-spectrum antibiotics, and corticosteroids, is essential to improve outcomes and preserve vital structures. Long-term follow-up is crucial to address functional and cosmetic sequelae. Further research is needed to develop evidence-based protocols, especially for toxic orbital cellulitis.