A rare asymptomatic metallic intraocular foreign body retained in the anterior chamber for 15 years: A case report

Intraocular foreign body in the anterior chamber angle misdiagnosed as herpetic stromal keratitis

We report a case of a metallic intraocular foreign body (IOFB) retained in the anterior chamber (AC) angle that was masquerading as herpetic stromal keratitis. A 41-year-old male construction worker was referred to our ophthalmology clinic with the complaint of consistent blurred vision for 3 days in his left eye. He had no history of ocular trauma. The best-corrected visual acuity was found to be 10/10 in the right eye and 8/10 in the left eye. On slit-lamp examination of the anterior segment, the right eye was normal, while the left eye showed unilateral corneal edema and scarring, anterior lens capsule opacification, +2 cells in the AC, and the Seidel test was negative. Fundus examination was normal bilaterally. Despite there not being history of it, we still suspected ocular trauma considering the patient's occupational risk. Consequently, an orbital computed tomography imaging was performed which revealed a metallic-IOFB in the inferior iridocorneal angle. On the second follow-up day, the corneal edema regressed, and a gonioscopic examination of the affected eye was performed, showing a small foreign body embedded in the inferior iridocorneal angle of the AC. Subsequently, the IOFB was surgically removed using Barkan lens, and excellent visual results were achieved. This case emphasizes the importance of considering IOFB in the differential diagnosis of patients with unilateral corneal edema and anterior lens capsule opacification. Fur-thermore, the presence of IOFB should be definitely excluded in patients with occupational risk of ocular trauma even if there is no history of trauma. More awareness about the proper use of eye protection should be raised to circumvent penetrating ocular-trauma.

Retained Metallic Intraocular Foreign Body With Excellent Visual Outcome

A healthy 25-year-old gentleman sustained a left eye perforating injury involving a metallic intraocular foreign body. Upon examination, his best-corrected visual acuity was 6/6 in the right eye and 1/60 in the left eye. There was a full thickness cornea-scleral laceration wound with uveal tissue prolapse at 7 o’clock. The pupil was peaked inferonasally. The anterior chamber was deep with cells grade 4+ and a hyphema level. The posterior segment could not be visualized due to a vitreous haemorrhage. The computed tomography scan revealed a high-density foreign body embedded in the posterior wall of the globe. He underwent primary toilet and suturing of the left eye cornea-scleral laceration, followed by pars plana vitrectomy with an endolaser and gas tamponade. However, the foreign body could not be identified intraoperatively. Post-operation, the left eye vision improved, achieving his premorbid best-corrected visual acuity of 6/6 by six months post-op. The intraocular foreign body was managed conservatively in view of the excellent visual acuity and the risk of further surgery. The patient has remained asymptomatic since then until his last follow-up at 30 months post-operation.