Background

Intraocular foreign bodies (IOFBs) are rather variable in presentation, outcome, and prognosis. With increased awareness and advanced surgical techniques, the outcome and the prognosis for these potentially devastating injuries have substantially improved.

The most important limiting factor today is the damage occurring at the time of the initial injury. One effective method appears to be prophylactic chorioretinectomy (see Surgical Care), which reduces the risk of postinjury proliferative vitreoretinopathy (PVR).

Metal intraocular foreign body located in the left temporal pars plana region seen on axial CT scan.

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Pathophysiology

The final resting place of and damage caused by an IOFB depend on several factors, including the size, the shape, and the momentum of the object at the time of impact, as well as the site of ocular penetration.^{[1, 2]}

IOFBs transversing the lens are less likely to cause major retinal damage; conversely, a smaller wound size usually means deeper penetration.

In addition to the initial damage caused at the time of impact, the risk of endophthalmitis and subsequent scarring (eg, PVR) play an important role in the planning of the surgical intervention.^[3]

Frequency

United States

According to the United States Eye Injury Registry (USEIR), the surveillance arm of the American Society of Ocular Trauma (ASOT), the incidence among eyes with open-globe injury is 16% in the United States. The most common cause is hammering; the incidence over time shows a decrease at the workplace and an increase in the home.^[4]

International

The frequency greatly varies (up to 41%) worldwide, depending upon the population surveyed.

Mortality/Morbidity

Most IOFBs cause internal damage, and most will come to rest in the posterior segment. Commonly injured structures include the cornea, the lens, and the retina.

Race

No racial predilection has been found so far.

Sex

According to the USEIR, 93% of patients with IOFBs are male.

Age

According to the USEIR, the average patient is aged 31 years.

Clinical Presentation

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Media Gallery

Metal intraocular foreign body located in the left temporal pars plana region seen on axial CT scan.
Same metallic intraocular foreign body as in previous image, as seen on coronal CT scan view.

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Author

Ferenc Kuhn, MD, PhD Associate Professor of Clinical Ophthalmology, University of Alabama at Birmingham; Consulting Staff, American Society of Ocular Trauma, Helen Keller Foundation for Research and Education, Chief Vitreoretinal Surgeon, Milos Klinika, Belgrade, Serbia

Disclosure: Nothing to disclose.

Coauthor(s)

David T Wong, MD, FRCSC Associate Professor of Ophthalmology and Vision Sciences, Department of Ophthalmology and Vision Sciences, University of Toronto Faculty of Medicine; Ophthalmologist-in-Chief, St Michael's Hospital, Canada

David T Wong, MD, FRCSC is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, Canadian Medical Association, Canadian Ophthalmological Society, College of Physicians and Surgeons of Ontario, Ontario Medical Association, Royal College of Physicians and Surgeons of Canada

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Novartis, Alcon, Bayer<br/>Received research grant from: Novartis, Alcon, Bayer, Genetech<br/>Received consulting fee from Alcon for consulting; Received consulting fee from Novartis for consulting; Received consulting fee from Bayer for consulting; Received consulting fee from Allergan for consulting; Received consulting fee from B & L for consulting.

Louis Giavedoni, MD, FRCSE Co-Chief, Assistant Professor, Department of Ophthalmology, St Michael's Hospital, University of Toronto, Canada

Louis Giavedoni, MD, FRCSE is a member of the following medical societies: American Academy of Ophthalmology, Canadian Medical Association, Canadian Ophthalmological Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Steve Charles, MD Founder and CEO of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine

Disclosure: Received royalty and consulting fees for: Alcon Laboratories.

Chief Editor

Inci Irak Dersu, MD, MPH Associate Professor of Clinical Ophthalmology, State University of New York Downstate College of Medicine; Attending Physician, SUNY Downstate Medical Center, Kings County Hospital, and VA Harbor Health Care System

Inci Irak Dersu, MD, MPH is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Additional Contributors

Andrew W Lawton, MD Neuro-Ophthalmology, Ochsner Health Services

Andrew W Lawton, MD is a member of the following medical societies: American Academy of Ophthalmology, Arkansas Medical Society, Southern Medical Association

Disclosure: Nothing to disclose.