Symptoms
Eye pain, decreased vision, or may be asymptomatic; often suggestive history (e.g., hammering metal or sharp object entering globe).
Signs
(See Figure 3.15.1.)
Critical
May have a clinically detectable corneal or scleral perforation site, hole in the iris, focal lens opacity, or an IOFB. IOFBs are often seen on CT scan (thin cuts), B-scan, and/or UBM.
Other
See 3.14, RUPTURED GLOBE AND PENETRATING OCULAR INJURY. Also, microcystic (epithelial) edema of the peripheral cornea (a clue that a foreign body may be hidden in the AC angle in the same sector of the eye). Long-standing iron-containing IOFBs may cause siderosis, manifesting as anisocoria, heterochromia, corneal endothelial and epithelial deposits, anterior subcapsular cataracts, lens dislocation, retinopathy, and optic atrophy.
Types of Foreign Bodies
Workup
Treatment
NOTE: |
Fluoroquinolones are contraindicated in children and pregnant women. |
Follow Up
Observe the patient closely in the hospital for signs of inflammation or infection. If the surgeon is uncertain as to whether the foreign body was entirely removed, postoperative imaging should be considered with CT, B-scan, or UBM as above. Periodic follow up for years is required; watch for a delayed inflammatory reaction in both the traumatic and nontraumatic eye. When an IOFB is left in place, an electroretinogram (ERG) should be obtained as soon as it can be done safely. Serial ERGs should be followed to look for toxic retinopathy, which will often reverse if the foreign body is removed.