Occult plastic intravitreal foreign body retained for 30 years: a case report

Incidental finding of a retained intracorneal wooden foreign body

We present a case of an intracorneal wooden foreign body that remained undetected for 15 years following an ocular injury sustained during gardening. The patient presented with stable visual acuity despite the long-standing presence of a wooden splinter embedded in the cornea. Interestingly, Pentacam corneal tomography did not show any abnormalities despite the foreign body piercing through the corneal stroma and endothelium. This case may serve as an opportunity to re-examine the approach to managing chronic and stable intracorneal wooden foreign bodies and explore the implications of continued observation rather than surgical management.

Retained polyvinyl chloride fragments in the cornea following trauma

Purpose

PVC is a synthetic plastic polymer used worldwide for a wide range of applications. While it is often associated with ocular trauma, little is known regarding how PVC may interact with ocular tissues. Herein we report the clinical course of a patient with polyvinyl chloride (PVC) embedded in the cornea after a projectile injury, utilizing anterior segment optical tomography to study the relative antigenicity and reactivity of this industrial material in the cornea.

Observations

A 29-year-old male presented with acute, unilateral vision loss in the left eye following ocular trauma while working with PVC. On exam, he had a near full-thickness corneal laceration with multiple small fragments of PVC in the corneal stroma. Given the small size and depth of the fragments, the patient was medically managed with close follow-up. After 6 days, his visual acuity returned to baseline and the corneal laceration was found to be well healed. Anterior OCT imaging identified discrete, individual fragments and there was no associated inflammatory response. At 3 months, the patient continued to do well with no signs of ocular inflammation.

Conclusions and Importance

PVC is a commonly used plastic in workplace settings that pose a risk for projectile injuries to the eye. This case highlights that at least in the short-term, PVC appears to be inert in the corneal stroma, allowing for medical management and close follow-up, rather than surgical removal.

PENETRATING OCULAR INJURY WITH RETAINED INTRAOCULAR FOREIGN BODY FROM DRYWALL

PURPOSE

To present a case of open globe injury and retained intraocular foreign body secondary to drywall.

METHODS

Interventional case report.

RESULTS

A 21-year-old man presented with corneal laceration, iris defect, and vitreous hemorrhage after hammering drywall. Computed tomography scan was negative for intraocular foreign body, but a drywall intraretinal foreign body was found on 25-gauge vitrectomy. Intraoperative findings and 6-month follow-up are presented.

CONCLUSION

Intraocular foreign body must always be suspected in all cases of penetrating ocular trauma. Although magnetic resonance imaging is ideal in diagnosing nonmetallic foreign bodies, computed tomography scan with Hounsfield units should be used in an emergency setting.

Multimodal imaging features of intraocular foreign bodies

Objective: To determine the imaging approach for evaluating intraocular foreign bodies (IOFBs) by comparing the ability of different modalities [plain film x-ray, computed tomography (CT), magnetic resonsance imaging (MRI), convetional ultrasound, and ultrasound biomicroscopy] to detect and characterize IOFBs.Methods & Design: Systematic review of the literature.Results: CT is the most practical first step for evaluating patients with suspected IOFBs because it can detect a wide range of IOFB types at small limitis of detection. MRI and ultrasound are best reserved as adjunctive tests in most cases although these tests may provide important insights especially with wood, plastic, and glass IOFBs. Imaging characteristics of metal, wood, glass, plastic, stone, concrete, and graphite IOFBs are reviewed.Conclusion: Understanding the limits of detection for each IOFB type and imaging modality as well as the characteristic features of different IOFBs is of paramount importance to optimizing the management of ocular trauma patients.

PENETRATING INJURY FROM PLASTIC AIRSOFT PELLET SHOWS BEAM-HARDENING ARTIFACT ON COMPUTER TOMOGRAPHY

PURPOSE

To describe a case of left eye corneal perforation, cataract, hyphema, and intraocular foreign body after airsoft pellet injury.

METHODS

The authors reviewed the medical history and diagnostic imaging of a 12-year-old boy injured by a pellet from an airsoft gun. Typically, plastic airsoft pellets cause blunt trauma to the globe, which can lead to visual disability from corneal abrasion or hyphema. Initial computed tomography of the left orbit showed a 6.1 mm × 7.6-mm radiodense foreign body with beam-hardening artifact, a radiographic feature associated with metallic objects.

RESULTS

The patient was taken to the operating room for globe repair, lensectomy, vitrectomy, and removal of intraocular foreign body. The removed foreign body was a plastic airsoft pellet.

CONCLUSION

This is the first report of a plastic intraocular foreign body showing beam-hardening artifact. This finding may have implications in the diagnosis and management of retained intraocular or intraorbital plastic foreign bodies.

A missed diagnosis of multiple intraocular foreign bodies for 21 years

A 30-year-old patient went to the emergency department because of a chemical burn to the left eye more than 10 days ago by toilet cleanser. Surprisingly, a small piece of glass was found in the inferior anterior chamber in the same eye. The visual acuity was counting fingers. There was conjunctival congestion, corneal oedema and Descemet's membrane striae. And there was also a corneal leukoma around 4 to 5 o'clock. Through repeated questioning he recalled that he was injured by an exploded light bulb around 21 years ago. He was asymptomatic until he saw "something moving" in front of the left eye one month ago. Computed tomography (CT) scanning, ultrasonography, ultrasound biomicroscopy (UBM), anterior segment optical coherence tomography (AS-OCT) verified the presence of multiple intraocular foreign bodies (IOFBs) in the anterior chamber and vitreous cavity. B-scan verified the IOFB in the vitreous cavity. Thus, he was diagnosed with corneal chemical burn, IOFBs and corneal leukoma of the left eye. The IOFB in the anterior chamber was removed through surgery. An attempt was made to remove the IOFB in the vitreous cavity with electromagnet, but it was not successful. Vitrectomy could not be performed as it was hindered by the opacity of cornea. After surgery, the visual acuity remained counting fingers and the corneal oedema still existed. This case is a reminder that a detailed history taking, a thorough physical examination and modern imaging techniques are beneficial for establishing the diagnosis and treatment of IOFBs.

A peculiar case of a retained inert piece of fireworks as an intraocular foreign body in the anterior chamber

This is a descriptive case report of a seven-year-old boy presented in January 2007 with decreased vision in the right eye, for 2 months after sustaining a trauma while he was playing with fireworks during the Eid holiday. He was treated in a suburban hospital for corneal laceration and was prescribed a topical antibiotic and a topical steroid. When the child presented to us, a slit lamp examination revealed a thread in the anterior chamber, his un-aided visual acuity was 6/60 on a Snellen chart. Surgery to remove the foreign body was scheduled, but the patient never attended. The patient was lost to follow-up and returned in January 2011 with an un-aided visual acuity of 6/12, although the foreign body was retained in the anterior chamber (AC) with a quiet eye and good vision. At that time, we decided to follow the patient without any surgical intervention. Again, the patient was lost to follow-up and returned with almost full vision in September 2012, with a visual acuity of 6/6 without correction. Thus, we concluded that thread like IOFBs in the AC can be considered inert materials that may not need any surgical intervention in a quiet eye that does not show any signs of inflammation and where the IOFB is non-mobile and located away from the endothelium.

Unusual presentation of an intraocular foreign body retained for sixty years

Intraocular foreign bodies may remain quiescent for many years particularly if they are not metallic. We report a case of a missed intraocular stone foreign body that had remained asymptomatic underneath the iris for 60 years and appeared during cataract surgery.

Metallic intraocular foreign body retained for four years--an unusual presentation

Intraocular foreign bodies present a great threat to both sight and the globe of the patient especially if they are metallic and of long duration. We report a case of a metallic intraocular foreign body that presented four years after the initial trauma. The case was successfully managed by a simple technique and the role of ultrasound biomicroscopy (UBM) is highlighted.

Causes and treatments of traumatic secondary glaucoma

PURPOSE

To study the cause, treatment, and cure of traumatic secondary glaucoma in 103 cases (103 eyes).

METHODS

The records of 103 patients (103 eyes) were reviewed. Causes of the high intraocular pressure (IOP) were analyzed according to the time after trauma. Most patients achieved a better visual acuity and ideal IOP after positive medical, neodymium:Yttrium aluminium garnet (Nd:YAG) laser, or surgical treatment. The operations included anterior chamber irrigation, filtering operation combined with mitomycin C, lensectomy, vitrectomy, and combination surgery.

RESULTS

Clinical findings of secondary glaucoma associated with ocular trauma are complex. Causes resulting in high IOP include intraocular bleeding, lens dislocation, phacoanaphylaxis, angle recession, and siderosis. After medical, laser, or surgical treatment, the IOP of most patients could be ideally controlled. After follow-up for half a year, the IOP of 3 cases (2.91%) was below 10 mmHg and 92 (89.32%) cases between 10 and 21 mmHg; only 8 cases (7.77%) still had IOP over 21 mmHg.

CONCLUSIONS

In traumatic secondary glaucoma, antiglaucoma medication should be used at the early stage, and surgery should be carried out when medical treatment does not reduce the elevated IOP, or in difficult cases to avoid severe complications. The postoperative IOP of most injured eyes was controlled within the safe range.

A case of an asymptomatic intralenticular foreign body

The purpose of this article is to report a case of an asymptomatic intralenticular metallic foreign body that was retained for 6 months. A 66-year-old male visited our ophthalmology department because of decreased visual acuity in his left eye 6 months after he suffered ocular trauma while mowing. He had not been treated because he did not experience any discomfort. His corrected visual acuity was 0.4. Central corneal opacity, an intralenticular metallic foreign body, and an intact posterior capsule were observed on slit lamp examination. Phacoemulsification with posterior chamber lens implantation and simultaneous removal of the intralenticular foreign body was performed. Seventeen days after the operation, his corrected visual acuity was 1.0, the intraocular lens was well-seated, and there was no intraocular inflammation. In this case report, a patient was found to have an intralenticular metallic foreign body retained for 6 months. During this time he did not experience any ocular dysfunction due to the foreign body. Mowing accidents are common in Korea. Despite the absence of symptoms, patients reporting a history of lawn mowing should be thoroughly examined.