Intralenticular foreign body: A case report and literature review

An Itch to Dilate: A Case Report of an Intralenticular Foreign Body in a 57-Year-Old Man

A 57-year-old man presented with a foreign body sensation in the left eye after using a metal pellet air gun seven days prior. Following an unremarkable exam at urgent care, the patient was prescribed topical ointment and instructed to follow up with an ophthalmologist for continued problems. At ophthalmology, the patient reported decreased vision of 20/30 and pain with accommodation in the left eye. Intraocular pressure was 16 mmHg. A slit lamp examination of the left eye showed full thickness horizontal scarring superior to the visual axis with a negative Seidel sign. The iris was normal, and the anterior chamber was deep and quiet. There was a slight abnormal aberration of light in the lens on retro-illumination. After dilation, a large metallic foreign body inferiorly embedded in the anterior lens was noted, violating the anterior capsule. The foreign body was successfully removed using a magnetic probe. Following lens phacoemulsification and the removal of cortical material, the capsular bag was noted to be intact. An intraocular lens implant was placed and well-centered. The patient experienced no complications, and his vision improved to 20/20 the subsequent day. This case report demonstrates the need for high clinical suspicion of embedded foreign bodies in patients near high-speed projectiles and the importance of dilation to rule out the presence of intralenticular foreign bodies.

A rare intraocular foreign body resulting from a workplace accident

A 54-year-old man presented to the ophthalmic emergency department of our center with eye pain and blurred vision in his right eye following a workplace accident. Examination revealed a penetrating corneal injury with the presence of an intraocular foreign body (IOFB) involving the corneoscleral limbus, perforating the cornea, iris, anterior lens capsule, and lens. Immediate surgical intervention was carried out with the extraction of the IOFB, identified as an 8mm mussel shell fragment, and the removal of the resulting traumatic cataract. Both preoperative and postoperative examinations showed an attached retina with no signs of retinal tears or vitreous hemorrhage. Appropriate management in this case, along with the timely identification of the agent, led to favorable outcomes despite the size of the intraocular foreign body.

ULTRASOUND BIOMICROSCOPY AND ECHOGENIC EXTERNAL MARKER ASSISTED INTRAOCULAR FOREIGN BODY REMOVAL

PURPOSE

We report a novel method of intraoperative localization of a retained anterior intraocular foreign body (IOFB), using a combination of ultrasound biomicrosopy and an insulated needle.

METHODS

A retrospective case report of a 56-year-old man who presented with a right eye IOFB.

RESULTS

On presentation, vision was decreased in the right eye to count fingers with a small subconjunctival hemorrhage, but no other signs of a penetrating laceration. Orbital CT revealed an IOFB, and the initial vitrectomy failed to retrieve the IOFB. Then, during the subsequent vitrectomy, using an ultrasound compatible needle and an ultrasound biomicrosopy, we were able to precisely locate and remove the small anterior IOFB.

CONCLUSION

Retained IOFBs can lead to severe irreversible vision loss if not promptly removed. Ancillary imaging modalities and localization techniques can help locate occult IOFBs in difficult cases.

Metallic intralenticular foreign body removal without crystalline lens extraction: a case report

We describe a technique for metallic intralenticular foreign body (ILFB) removal in a patient in whom there was no or minimal cataract formation or other complications. This technique required creating two corneal small incisions around the ILFB for inserting iris retractors to expose the ILFB. At the foreign body position, a clear corneal incision was made, and then the ILFB was removed with minimal manipulation by an intraocular magnet without complications. Because most occupational traumas occur in young people, this technique avoids the adverse outcomes of lens extraction in this age group.

LAWN TRIMMER-RELATED OPEN-GLOBE INJURIES IN TAIWAN

PURPOSE

Work-related ocular trauma remains the leading cause of unilateral visual impairment worldwide. Many preventable work-related ocular injuries continue to occur, even at home. This study describes the characteristics, surgical techniques, and prognostic factors of lawn trimmer-related open-globe injuries in eastern Taiwan.

METHODS

This was a retrospective, consecutive case series study. Slit-lamp biomicroscopy, dilated fundoscopy, and orbital computed tomography (CT) images were collected.

RESULTS

Twenty-six eyes of 26 patients were enrolled in the study. Fifteen patients (57.7%) had an intraocular foreign body (IOFB). The IOFB was metallic in 13 cases and glass and stone in the other 2 cases. Seven IOFBs (46.7%) were retained in the anterior chamber, 7 (46.7%) in the posterior segment, and 1 (6.7%) in the intraconal space. Univariate analysis showed that the presence of IOFB trended toward the development of endophthalmitis; however, this was not statistically significant (hazard ratio, 2.25; 95% confidence interval 0.35-14.61; P = 0.658). Eleven patients had metallic IOFBs noted on CT scans with metal artifacts, whereas two patients had small metallic IOFBs without metal artifacts. One patient had a glass IOFB mimicking metal artifacts on the CT scan. In one case, CT failed to reveal the IOFB, and an intralenticular metallic foreign body was incidentally found intraoperatively.

CONCLUSION

Our study provides a broad characterization of lawn trimmer-related open-globe injuries. The informative and diverse findings of IOFBs on CT scans will help clinicians detect and recognize IOFBs more precisely and perform the surgery without causing further damage.

Disappeared intralenticular foreign body: A case report

BACKGROUND

Intralenticular foreign body is rarely encountered in ophthalmic practice. In most cases, subsequent traumatic cataract requires cataract surgery for visual rehabilitation.

CASE SUMMARY

A 35-year-old man was injured by iron filings in his left eye. After the injury, the patient tried to draw the object out by himself using a magnet; however, the foreign body (FB) was pushed to the equator of the lens. The FB was removed by a magnet through the anterior chamber accessed through the original capsular wound. Since most of the lens was transparent and only partially opaque after the operation, the lens was kept under close observation. After the surgery, the patient’s visual acuity reached 20/20 from 2/20, visual function recovered very well, and local opacity of the lens remained stable.

CONCLUSION

For intralenticular FB in the anterior cortex under the capsule, magnet may be a more advantageous way to remove the object.

Ocular siderosis resulting from a retained intralenticular metallic foreign body

Intraocular foreign bodies are a potential factor threatening with loss of vision. The development of cataract and symptoms of ocular siderosis are the most common signs of ferrous metal entering the eye. We present a case of a 45-year-old man who reported to the hospital for planned cataract surgery. He denied the possibility of any past eye injury. Despite this, apart from the cataract, X-ray and CT scans confirmed the presence of an intralenticular foreign body and symptoms of ocular siderosis. Cataract surgery was successfully performed using phacoemulsification, and the metallic foreign body was removed. Intraocular foreign body symptoms may be overlooked by patients and even physicians and may occur with considerable delay. Hence, in patients with indirect symptoms of penetrating eye injury, the presence of an intraocular foreign body should not be ruled out, even if the patient denies this possibility.