Journal Menu

Ocular trauma with Intraorbital foreign body

Lt Col ( Dr) Retd Gaurav Relhan*,Maj Gen (Dr) Retd JKS PARIHAR , Col (Dr) Jaya Kaushik and Dr Akanksha Relhan

Department of ophthalmology, MH Pathankot, India

*Corresponding author

Gaurav Relhan, Department of ophthalmology, MH Pathankot, India

Abstract

Intraocular foreign bodies (IOFBs) are commonly seen in ocular injuries, in that upto 40% of eyes with open globe injury will contain atleast one IOFB [1,2]. IOFBs most commonly inflict young males while hammering, using a machine tool, shooting a shotgun, or being in the vicinity of an explosion.

Keywords: Intraocular foreign body (IOFB); Endophthalmitis; Metallosis

Introduction

Intraocular foreign bodies (IOFBs) are commonly seen in ocular injuries, in that upto 40% of eyes with open globe injury will contain atleast one IOFB [1,2]. IOFBs most commonly inflict young males while hammering, using a machine tool, shooting a shotgun, or being in the vicinity of an explosion. Retained IOFBs represent a true emergency that can lead to severe vision loss due to endophthlmitis, retinal detachment, ciliary body dysfunction, ocular metallosis and even loss of eye despite the best efforts at treatment [3-5]. Since IOFB injuries occur in young and productive members of society, these injuries are costly both economically and personally.

Case Report

07-year-old boy presented with swelling at right upper eye lid, pain, diminution of vision of 1½ month duration. Got injured while playing football had a fall on a log of wood and a piece of it got pierced in his right upper eye lid. Thereafter, patient went to civil hospital for initial management where the protruding wooden part was removed and patient was sent back home.Subsequently,h/o diminution of vision, redness/ swelling in superior part of lid associated with painful ocular movements.

Ocular examination: Swelling over (R) upper lid with well-defined distinct margins. Surrounding area erythematous with mechanical Ptosis .On palpation the swelling was tender, soft , immobile about 1 x 1 cm in size with well-defined margins. Distant visual acuity (Unaided) - (R) eye 6/12 not improving with pinhole, (L) eye 6/6.Intraocular Pressure - (R) 12 mm Hg, (L) 14 mm Hg.Pupils- central circular reacting to light equally in both eyes,No RAPD seen.Ocular movements in Rt eye painful in superior, (R) and (L) gazes. Conjunctival congestion present in superior bulbar and palpebral portion. Cornea - clear , shiny and lustorous .Limbus - healthy with intact vasculature. Ant. Chamber - normal in depth and contents. Lens - clear , no opacities visible.Vitreous - No retrolental cells and flare. Fundus - WNL .

  • NCCT Orbit
  • Management- Patient was admitted and was worked up for exploration and removal of foreign body.Patient was started on IV antibiotics - Inj Cefotaxime 1gm 8 hrly, Inj Amikacin - 150 mg 12 hrly , Inj Voriconazole - 80 mg 12 hrly. Taken up for surgery through lateral brow incision and IOFB removal done under GA.Risks and challenges during surgery : Deep seated foreign body,injury to orbital vessels and nerves,orbital cellulitis,cavernous sinus thrombosis.
  • Continued IV antibiotics for 5 days.Post op period uneventful.Discharged on post op day 7.Distant Visual acuity at discharge 6/6 and ocular movements were full and free

Discussion

Management of an IOFB injury requires immediate closure of the globe and removal of the IOFB. A delay in primary repair and IOFB removal of greater than 24 hrs increases 4-fold risk of endophthalmitis and severe vision loss. Prompt IOFB removal before encapsulation facilitates removal and limits intraocular toxicity from the IOFB. All eyes suspected of harbouring IOFB should receive appropriate testing to confirm or rule out the presence of an IOFB.Standard tests include CT, USG or on occasion MRI though one must be certain that the IOFB is not magnetic.Techniques for IOFB extraction include the use of magnets,intraocular forceps and scleral cutdowns.The method that provides the greatest control of the eye with the least surgical trauma should be chosen [6].

Potentially blinding complications of IOFB injuries include endophthalmitis,retinal detachment with proliferative vitreoretinopathy, metallosis and choroidal neovascularisation.All can present in immediate or delayed fashion. It is somewhat disheartening that nearly 3 decades of microsurgical experience have not significantly improved the prognosis for patients with IOFB injuries. Possible explanation may be that the trauma characteristics of the initial injury primarily determine the visual outcome despite optimum management [3].

While there are always new therapeutic modalities in the management of IOFB injuries, the greatest area for improvement may be in prevention of such injuries. Up to 90% of work related injuries may be avoided with the use of protective eyewear [7]. Demonstrations that the use of safety glasses in the workplace may be as low as 6% suggest that prevention is presently inadequate [8].

Conclusion

Patients with retained IOFBs present with multitude of ocular findings.Patients should be fully assessed and surgery must be performed timely depending upon the location and composition of the IOFB. In the majoirty of cases the IOFB can be successfully removed and significant vision can be restored with timely intervention.

Conflicts of interest
All authors have none to declare

REFERENCES

  1. Shock JP, Adams D (1985) Long-term visual acuity results after penetrating and perforating ocular injuries. Am J Ophthalmol 100: 714-718.
  2. Thompson JT, Parver LM, Enger CL (1993) Infectious endophthalmitis after penetrating injuries with retained intraocular foreign bodies. Ophthalmol. 100: 1468-1474.
  3. Williams DF, Mieler WF, Abrams GW, Lewis H (1988) Results and prognostic factors in penetrating ocular injuries with retained intraocular foreign bodies. Ophthalmol 95: 911-916.
  4. Behrens-Baumann W, Praetorius G (1989) Intraocular foreign bodies. Ophthalmologica198: 84-88.
  5. Schwartz JG, Somerest JS, Harrison JM (1991) Eye injuries with metal missiles presenting to an emergency center.Am J Emerg Med 9: 313-317.
  6. Spalding SC, Sternberg P Jr (1990) Controversies in the management of posterior segment ocular trauma.Retina 10(S): S76-82.
  7. Jones NP, Griffith GA (1992) Eye injuries at workplace: A prospective population-based survey within the chemical industry. Eye 6: 381-385.
  8. Dannenberg AL, Parver LM, Brechner RJ, Khoo L (1992) Penetrating eye injuries in the work place: The national eye trauma system registry.Arch Ophthalmol 110:843-848.

JCMCRI
ISSN: 3064-8025

Journal of Clinical & Medical Case Reports, Images (JCMCRI) ISSN: 3064-8025 is a peer-reviewed journal dedicated to publishing clinical images from all sectors of medicine. The goal of this magazine is to disseminate information about new discoveries and treatments in science and medicine.

Quick Links

OTHER LINKS

Contact Us

support@jcmcrimages.org

Frisco, Texas 75070, USA

Copyright ©2024 All rights reserved

TOP