- Iron –> siderosis
- Copper –> chalcosis
- Nickel (severe inflammation)
- Mercury –> phthisis bulbi (rapid)
- Zinc (minimal inflammation)
- Aluminium (minimal inflammation)
Stepwise apporach to Open Globe Injury (OGI) with IOFB:
- Systematic evalutaion – rule out any life-threatening injuries
- History – aetiology, type of material, time of injury, last meal and allergies
- Examination – VA, RAPD, dilated fundal exam (IOFB, RD).
- B-scan but very gentle if necessary
- Broad spectrum antibiotics (eg. oral ciprofloxacin 750mg BD) & tetanus jab.
- CT scan – intracranial FB or fracture.
- Thorough consultation consent process with patient.
- OGI with IOFB – decide whether to combine both or repair OGI first.
- Consider intravitreal antibiotics + vitreous biopsy for post-traumatic endophthalmitis.
- If traumatic cataract – pars plana lensectomy then left aphakic for secondary IOL 3-6 months later.
- PPV – core PPV –> PVD induction important to prevent iatrogenic breaks during removal of IOFB.
- Removal of IOFB – IOFB endomagnet (1 mm size) / basket forceps (1-3mm) / diamond-coated FB forceps (3-5mm) / scleral tunnel or limbal incision (> 5mm).
- Use silicone oil for severe cases to prevent PVR. Otherwise, can use other tamponades depending on findings.
- Monitor cornea – easily oedema during surgery if damaged.
- Scleral buckle – usually encirclement (depending on surgeon preference and case)
Prognosis – poor if develop suprachoroidal haemorrhage (around 5%), PVR (around 10%) or endophthalmitis (average 5%).