Intraocular foreign body missed by radiography

Variations in clinical manifestations and outcomes of penetrating ocular injuries with intraocular foreign bodies: a case series

Intraocular foreign bodies (IOFBs) are the most common emergency cases in ophthalmology causing severe visual impairment to blindness. We present nine male patients with IOFBs, aged 28-64 years old, which displayed a wide spectrum of findings. Based on IOFB location, four cases were intravitreal, two were intraretinal, two were intralenticular and one was intracorneal. The most common material was metal, from hammering projectiles (six patients). The injuries mainly occurred at workplace (five patients). All IOFBs were successfully extracted. Initial visual acuity (VA) ranged from light perception to 20/32; six patients had better final VA, up to 20/20. A wide range of ocular manifestations is associated with IOFBs. Removing retained IOFB procedure is dependent on location, nature, lens opacity and vitreoretinal involvement. Meticulous ocular examination and imaging modality are vital to identify the IOFB presence. Various visual outcomes depend on zone involvement, IOFB size and level of difficulties of surgery.

Intraocular foreign bodies: A review

Intraocular foreign body injuries may result in a wide range of intraocular pathology and visual outcomes based on the mechanism of injury, type of foreign body, and subsequent complications. We have reviewed the literature to describe the epidemiology and mechanisms of such injuries; types of foreign bodies; imaging tools for diagnosis; current trends in management, presurgical, and surgical interventions; as well as visual prognosis and potential complications. The purpose of this review is to familiarize clinicians with the recent advances in diagnosis and management of such injuries.

C-arm fluoroscopy for the removal of an intraorbital foreign body in a cat

This report describes the clinical manifestations, diagnosis and minimally surgical intervention of a cat with an intraorbital foreign body. A spayed female cat of unknown age was presented with a recurrent cutaneous sinus tract of the left suborbital region. The cat had not vocalized at all since the adoption. A sharp-edged radiopaque foreign body was visualized on dental radiography. Computed tomography outlined the length of the foreign body from the intraorbital soft tissue to the pharynx. The foreign body was removed under the guide of C-arm fluoroscope with minimal skin incision. The surgical site healed completely on the 11th postoperative day, and the cat vocalized normally after healing.

Lens siderosis resulting from a tiny missed intralenticular foreign body

We report a patient with clinical ocular siderosis at the time of presentation but undetectable intraocular foreign body on computed tomography (CT) and ultrasonography. A 24-year-old man suffered from right ocular injury when hammering metal on metal. Slit-lamp examination revealed a small corneal perforating wound and an iris hole, but no intraocular foreign body was found under fundus examination. There was also no evidence of intraocular foreign body on ultrasonography and orbital CT scan. About 1 month later, lens siderosis with cataract formation developed, and the patient received lens extraction with intraocular lens implantation. During the operation, a small (< 1 x 1 x 1 mm in size) intralenticular foreign body of metal material was found and removed. The patient's visual acuity improved from 6/20 to 6/6 on the next day. A patient suspected to have intraocular foreign body should be followed-up closely; it is better to remove the foreign body before siderosis bulbi occurs.

Plain X-ray and computed tomography of the orbit in cases and suspected cases of intraocular foreign body

AIM

To evaluate the roles of plain X-ray and computed tomography (CT) orbital imaging in cases and suspected cases of intraocular foreign body (IOFB).

METHODS

Retrospective review of clinical and radiological data relating to 204 consecutive cases and suspected cases of IOFB.SettingRoyal Victoria Eye and Ear Hospital, Dublin, Ireland.

RESULTS

Plain X-rays were performed in the absence of clinically evident ocular penetration in 177 (87%) cases, and no IOFB was demonstrated in any of these radiographs. Twenty-seven (13%) plain X-ray radiographs were obtained in the presence of clinically evident ocular penetration, and an IOFB was clinically visible in 19 (70%) of these cases. CT scans were undertaken in 21 (10%) of the 204 patients. Of these CT images, 9 (43%) and 12 (57%) were undertaken in the absence and presence of clinically evident ocular penetration, respectively. None (0%) and all (100%) of the CT scans obtained in the absence and presence of clinically evident ocular penetration demonstrated an IOFB, respectively.

CONCLUSION

Plain X-ray and CT orbital imaging are non-contributory in the absence of clinically evident ocular penetration. In the presence of clinically evident ocular penetration, and where an IOFB is clinically visible, plain X-ray orbital radiography may have a role in excluding multiple IOFBs. In the presence of clinically evident ocular penetration, but where an IOFB is not clinically visible, CT orbital imaging remains the investigation of choice, and the role of pre-CT plain X-ray orbital radiography, as recommended by the guidelines of the Royal College of Radiologists, merits re-evaluation.

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

A 41-year-old man had suffered trauma to the right eye 30 years ago. In March 1996, he underwent trabeculectomy and peripheral iridectomy under the diagnosis of open angle glaucoma in the right eye. Autoperimetry at that time revealed visual field constriction. In addition, ocular examination showed that the cup/disc ratio of his right eye was increased. Cataract was diagnosed in September 2002 and cataract extraction was performed on October 22, 2002. Aplastic intravitreal foreign body was detected during the operation. However, preoperative B-scan ultrasonography had failed to detect an intraocular foreign body (IOFB), and the previous fluorescein angiography had shown only retinal pigment epithelium changes. This case reminded us that we should be alert to an occult IOFB in the event of ocular trauma, even if none had been detected during prior imaging examinations.

Orbital cellulitis and intraocular abscess caused by migrating grass in a cat

We report an unusual case of orbital cellulitis in a cat. Drainage via the pterygopalatine fossa and medical treatment were performed. Failure of resolution and loss of ocular structure and visual function with a poor prognosis led to enucleation. During surgery, plant material and purulent exudate were present in the orbit. Histopathology showed an intraocular foreign body of grass that had migrated through the sclera causing a suprachoroidal abscess with choroidal and retinal detachment.

Eyelid foreign body mimics an intraocular foreign body on plain orbital radiography

Localization of a foreign body detected on plain orbital radiography may be achieved by comparing radiographs taken with the eyes in upgaze and downgaze. Movement of the foreign body with ocular rotation is considered to indicate localization either within the globe itself or within the soft tissues of the orbit closely related to the globe. A case is reported that demonstrates that this radiologic feature may also occur when a foreign body is located within an eyelid because the position of the eyelids also changes on vertical eye movements. An eyelid foreign body may therefore mimic an intraocular foreign body on plain orbital radiography.

Foreign bodies in the eye

'I think I have got something in my eye.' This statement is one of the most common that patients make in any A & E department. For the nurse at triage, it is the beginning of an investigation that should establish a number of important historical facts: 1. How painful is the eye? 2. Is this foreign body of a high or low velocity? 3. What is the foreign body: dust, wood, metal, glass? 4. Was the patient wearing spectacles or contact lenses? 5. Has there been any alteration in the patients vision/sensitivity to light? Establishing these important historical facts will help the nurse determine the likelihood of this injury being a minor or major problem.