eMedicine Specialties > Ophthalmology > Vitreous

Foreign Body, Intraocular

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
Coauthor(s): David T Wong, MD, FRCS(C), Associate Professor of Ophthalmology, Director of Fellowship Programs, Department of Ophthalmology, St Michael's Hospital, Faculty of Medicine, University of Toronto, Canada; Louis Giavedoni, MD, FRCSE, Co-Chief, Assistant Professor, Department of Ophthalmology, St Michael's Hospital, University of Toronto, Canada
Contributor Information and Disclosures

Updated: Dec 3, 2008

Introduction

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).

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.

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.

Frequency

United States

According to the United States Eye Injury Registry (USEIR), the surveillance arm of the American Society of Ocular Trauma (ASOT), the frequency in the United States is 16%. The most common cause is hammering; the incidence over time shows a decrease at the workplace and an increase in the home.

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

History

A few direct questions should be sufficient for the ophthalmologist to suspect the presence of an IOFB in eyes with an open globe injury.

In case of doubt, it is advisable to err on the side of an IOFB presence. The most common cause for litigation against the ophthalmologist in a trauma case is a missed IOFB. It is important to remember that the patient may be unaware of any object entering (or even striking) the eye, and the vision may be unaffected initially.

Physical

A complete examination of both eyes is necessary, including the visual acuity.

  • A corneal entry wound and a hole in the iris provide trajectory information.
  • The slit lamp is extremely useful in detailing all anterior segment pathologies.
  • The indirect ophthalmoscope through a dilated pupil may allow direct visualization of the IOFB, which gives the most useful information for the surgeon.
  • Gonioscopy and scleral depression are not recommended unless the entry wound has been surgically closed.

Causes

Hammering and using power tools are the most important causes. Protective eyewear, if appropriate (3 mm of polycarbonate), prevents virtually all injuries.

More on Foreign Body, Intraocular

Overview: Foreign Body, Intraocular
Differential Diagnoses & Workup: Foreign Body, Intraocular
Treatment & Medication: Foreign Body, Intraocular
Follow-up: Foreign Body, Intraocular
Multimedia: Foreign Body, Intraocular
References
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References

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Further Reading

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Keywords

intraocular foreign body, IOFB, intraocular foreign bodies, IOFBs, endophthalmitis, ocular trauma, eye injury

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Contributor Information and Disclosures

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
Disclosure: Nothing to disclose.

Coauthor(s)

David T Wong, MD, FRCS(C), Associate Professor of Ophthalmology, Director of Fellowship Programs, Department of Ophthalmology, St Michael's Hospital, Faculty of Medicine, University of Toronto, Canada
David T Wong, MD, FRCS(C) 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, and Royal College of Physicians and Surgeons of Canada
Disclosure: Alcon Consulting fee Consulting; Novartis Consulting fee Consulting; Alcon Grant/research funds Other; Labtician Consulting fee 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, and Canadian Ophthalmological Society
Disclosure: Nothing to disclose.

Medical Editor

Andrew W Lawton, MD, Medical Director of Neuro-Ophthalmology Service, Section of Ophthalmology, Baptist Eye Center, Baptist Health Medical Center
Andrew W Lawton, MD is a member of the following medical societies: American Academy of Ophthalmology, Arkansas Medical Society, and Southern Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Steve Charles, MD, Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine
Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Club Jules Gonin, Macula Society, and Retina Society
Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest Consulting

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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