Intraocular foreign body

Reactive materials:

  • Iron –> siderosis
  • Copper –> chalcosis
  • Nickel (severe inflammation)
  • Mercury –> phthisis bulbi (rapid)
  • Zinc (minimal inflammation)
  • Aluminium (minimal inflammation)

Inert materials:

  • Plastic
  • Glass
  • Sand
  • Stone

Stepwise apporach to Open Globe Injury (OGI) with IOFB:

  1. Systematic evalutaion – rule out any life-threatening injuries
  2. History – aetiology, type of material, time of injury, last meal and allergies
  3. Examination – VA, RAPD, dilated fundal exam (IOFB, RD).
  4. B-scan but very gentle if necessary
  5. Broad spectrum antibiotics (eg. oral ciprofloxacin 750mg BD) & tetanus jab.
  6. CT scan – intracranial FB or fracture.
  7. Thorough consultation consent process with patient.
  8. OGI with IOFB – decide whether to combine both or repair OGI first.
  9. Consider intravitreal antibiotics + vitreous biopsy for post-traumatic endophthalmitis.
  10. If traumatic cataract – pars plana lensectomy then left aphakic for secondary IOL 3-6 months later.
  11. PPV – core PPV –> PVD induction important to prevent iatrogenic breaks during removal of IOFB.
  12. Removal of IOFB – IOFB endomagnet (1 mm size) / basket forceps (1-3mm) / diamond-coated FB forceps (3-5mm) / scleral tunnel or limbal incision (> 5mm).
  13. Use silicone oil for severe cases to prevent PVR. Otherwise, can use other tamponades depending on findings.
  14. Monitor cornea – easily oedema during surgery if damaged.
  15. 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%).

Recommended reference:

Location Birmingham Midlands Eye Centre 76 Dudley Road Birmingham B18 7QH UK Phone 0121 554 3801 Hours Mr Ch'ng | Vitreoretinal Clinic Sessions: Monday: 8.30am - 12.30pm Wednesday (alternate): 8.30am - 5.00pm Thursday: 8.30am - 12.30pm Friday: 8.30am - 12.30pm | Vitreoretinal Theatre Sessions: Wednesday (alternate): 8.30am - 5.00pm & Friday (emergency cases): 1.30pm - 5.00pm | Eye Casualty Session: Monday 1.00pm - 4.30pm |
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