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Intraocular Foreign Body Treatment & Management

  • Author: Ferenc Kuhn, MD, PhD; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Mar 17, 2015
 

Medical Care

Systemic and topical antibiotic therapy may be started prior to the surgical intervention. Topical corticosteroids are also important to minimize the inflammation. A tetanus booster may also be appropriate.

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Surgical Care

The timing of intervention is primarily determined by whether the risk of endophthalmitis is high. If the risk is high, immediate (emergency) surgery, for intraocular foreign body (IOFB) removal as well as vitrectomy if the IOFB is in the posterior segment, is indicated.[9] In most other cases, the surgeon has the option of deferring intervention for a few days to reduce the risk of intraoperative hemorrhage. The wound, however, should be closed as soon as possible. A study by Zhang et al examined 1421 eyes in 15 hospitals in China over 5 years and concluded that closing the primary wound within 24 hours, whether by repair or independent self-sealing, reduces the endophthalmitis risk.[10] If endophthalmitis occurs, it is present at the time of patient presentation in over 90% of the cases.[11, 12]

IOFBs in the anterior chamber are typically removed through a paracentesis (not through the original wound) performed at 90-180° from where the IOFB is located. Viscoelastics should be used to reduce the risk of iatrogenic damage to the corneal endothelium and the lens.

An intralenticular IOFB does not necessarily cause cataract. Unless there is a risk of siderosis or the loss to follow-up is high, the IOFB and the lens may be left in situ. Otherwise, usually, the IOFB is extracted first, the lens is extracted second, and an intraocular lens (IOL) is implanted simultaneously.[13]

A posterior segment IOFB requires a vitrectomy, unless the tissue damage is minimal. The posterior hyaloid should always be removed, and any deep impact should be prophylactically treated against proliferative vitreoretinopathy (PVR) (see below). For the actual removal, the best tool to extract a ferrous IOFB is a strong intraocular magnet. For nonmagnetic IOFBs, a proper forceps or a lasso may be used. External electromagnets should not be used since they do not allow controlled extraction.[14, 15, 16, 17]

Rarely, a scleral cut-down is used.

If the IOFB has caused a deep impact (ie, involving the choroid), prophylactic chorioretinectomy is recommended. Using the highest setting of the diathermy machine, the probe is used to destroy the retina and the choroid around the impact site, thereby leaving a bare sclera to surround the impact site.[18] In early clinical tests, this procedure has proven to be very effective in preventing both PVR and radiating retinal folds. The same technique may be used if a chronic IOFB is found to be causing full-thickness folds in the macula, a pathologic condition that tends to be highly disturbing to the patient.[19]

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Activity

No activity restriction is necessary once the wound heals and there is no need for positioning.

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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, 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<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 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, Macula Society, Retina Society, Club Jules Gonin

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

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, Pan-American Association of Ophthalmology

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.

References
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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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