Further Outpatient Care

Follow-up visits are necessary for at least 4 months to determine whether proliferative vitreoretinopathy has occurred. Rehabilitation service may be necessary if permanent visual impairment is present.

If retinal folds, radiating from a retinal impact site, develop and interfere with vision by reaching into the macula—and even seemingly inconspicuous folds can cause severe visual disturbance—late chorioretinectomy should be considered.^[20]

Further Inpatient Care

Unless serious complications are present, the patient can be discharged shortly after surgery.

Educate the patient about the potential of both early complications (eg, intraocular pressure elevation) and late complications (eg, scarring).

Inpatient & Outpatient Medications

Topical antibiotics and corticosteroids in the early postoperative period are indicated.

Deterrence/Prevention

Safety eyewear made of polycarbonate (3 mm in thickness) virtually eliminates the risk of intraocular foreign bodies (IOFBs).

Complications

Endophthalmitis, corneal scarring, elevated intraocular pressure, cataract, retinal detachment, proliferative vitreoretinopathy, and metallosis (eg, chalcosis, siderosis) are possible complications.^[21]

Prognosis

The prognosis is generally relatively good. Over one half of eyes with IOFB injury regain/retain reading vision.

Patient Education

Eye protection when partaking in risky activities (eg, hammering, mowing the lawn) is strongly recommended.^[22]

Boldt HC, Pulido JS, Blodi CF, et al. Rural endophthalmitis. Ophthalmology. 1989 Dec. 96(12):1722-6. [QxMD MEDLINE Link].
Potts AM, Distler JA. Shape factor in the penetration of intraocular foreign bodies. Am J Ophthalmol. 1986. 100:183-187.
Knox FA, Best RM, Kinsella F, et al. Management of endophthalmitis with retained intraocular foreign body. Eye. 2004 Feb. 18(2):179-82. [QxMD MEDLINE Link].
Brown IA. Intraocular foreign bodies. Nature of injury. Int Ophthalmol Clin. 1968 Spring. 8(1):147-52. [QxMD MEDLINE Link].
Cooke CA, Mulholland DA. A closer look at anterior segment intraocular foreign bodies. Eye. 2005 Apr. 19(4):476-8. [QxMD MEDLINE Link].
Mieler WF, Ellis MK, Williams DF, et al. Retained intraocular foreign bodies and endophthalmitis. Ophthalmology. 1990 Nov. 97(11):1532-8. [QxMD MEDLINE Link].
Coleman DJ, Jack RL, Franzen LA. Ultrasonography in ocular trauma. Am J Ophthalmol. 1973 Feb. 75(2):279-88. [QxMD MEDLINE Link].
Penner R, Passmore JW. Magnetic vs nonmagnetic intraocular foreign bodies. An ultrasonic determination. Arch Ophthalmol. 1966 Nov. 76(5):676-7. [QxMD MEDLINE Link].
Kuhn F, Morris R, Witherspoon CD. Intraocular foreign body (posterior segment). In: Masters Techniques in Ophthalmic Surgery. Baltimore: Williams and Wilkins;. 1995:1201-1212.
Zhang Y, Zhang M, Jiang C, Qiu HY. Intraocular foreign bodies in china: clinical characteristics, prognostic factors, and visual outcomes in 1421 eyes. Am J Ophthalmol. 2011 Jul. 152(1):66-73.e1. [QxMD MEDLINE Link].
Demircan N, Soylu M, Yagmur M, et al. Pars plana vitrectomy in ocular injury with intraocular foreign body. J Trauma. 2005 Nov. 59(5):1216-8. [QxMD MEDLINE Link].
Thompson JT, Parver LM, Enger CL, et al. Infectious endophthalmitis after penetrating injuries with retained intraocular foreign bodies. National Eye Trauma System. Ophthalmology. 1993 Oct. 100(10):1468-74. [QxMD MEDLINE Link].
Kumar A, Kumar V, Dapling RB. Traumatic cataract and intralenticular foreign body. Clin Experiment Ophthalmol. 2005 Dec. 33(6):660-1. [QxMD MEDLINE Link].
Cridland N. Magnetic extraction. Int Ophthalmol Clin. 1986. 8(1):213-29.
Kuhn F, Heimann K. [A new permanent magnet for removal of intra-ocular ferromagnetic foreign bodies]. Klin Monatsbl Augenheilkd. 1991 Apr. 198(4):301-3. [QxMD MEDLINE Link].
Lo Bue TD, Deutsch TA, Lobick J. Detection and localization of nonmetallic intraocular foreign bodies by magnetic resonance imaging. Arch Ophthalmol. 1988. 106(2):260-1.
Soheilian M, Abolhasani A, Ahmadieh H, et al. Management of magnetic intravitreal foreign bodies in 71 eyes. Ophthalmic Surg Lasers Imaging. 2004 Sep-Oct. 35(5):372-8. [QxMD MEDLINE Link].
Michels RG, Rice TA. Bimanual bipolar diathermy for treatment of bleeding from the anterior chamber angle. Am J Ophthalmol. 1977 Dec. 84(6):873-4. [QxMD MEDLINE Link].
Kuhn F, Teixeira S, Pelayes DE. Late versus prophylactic chorioretinectomy for the prevention of trauma-related proliferative vitreoretinopathy. Ophthalmic Res. 2012. 48 Suppl 1:32-7. [QxMD MEDLINE Link].
Kuhn F, Teixeira S, Pelayes DE. Late versus prophylactic chorioretinectomy for the prevention of trauma-related proliferative vitreoretinopathy. Ophthalmic Res. 2012. 48 Suppl 1:32-7. [QxMD MEDLINE Link].
Weissgold DJ, Kaushal P. Late onset of rhegmatogenous retinal detachments after successful posterior segment intraocular foreign body removal. Br J Ophthalmol. 2005 Mar. 89(3):327-31. [QxMD MEDLINE Link].
Lubniewski A, Olk RJ, Grand MG. Ocular dangers in the garden. A new menace--nylon line lawn trimmers. Ophthalmology. 1988 Jul. 95(7):906-10. [QxMD MEDLINE Link].
Azad RV, Kumar N, Sharma YR, et al. Role of prophylactic scleral buckling in the management of retained intraocular foreign bodies. Clin Experiment Ophthalmol. 2004 Feb. 32(1):58-61. [QxMD MEDLINE Link].
Barry DR. Effects of retained intraocular foreign bodies. Int Ophthalmol Clin. 1968 Spring. 8(1):153-70. [QxMD MEDLINE Link].
Behrens-Braumann W, Praetorius G. Intraocular foreign bodies: 297 consecutive cases. Ophthalmologica. 1989. 198(2):84-8.
Coleman DJ, Lucas BC, Rondeau MJ, et al. Management of intraocular foreign bodies. Ophthalmology. 1987 Dec. 94(12):1647-53. [QxMD MEDLINE Link].
Duker JS, Fischer DH. Occult plastic intraocular foreign body. Ophthalmic Surg. 1989 Mar. 20(3):169-70. [QxMD MEDLINE Link].
Erakgun T, Akkin C, Mentes J. Management of the posterior segment foreign bodies with a simple snare. Retina. 2003 Dec. 23(6):858-60. [QxMD MEDLINE Link].
Johnston S. Perforating eye injuries: a five year survey. Trans Ophthalmol Soc U K. 1971. 91:895-921. [QxMD MEDLINE Link].
Kuhn F, Mester V, Morris R. A proactive treatment approach for eyes with perforating injury. Klin Monatsbl Augenheilkd. 2004 Aug. 221(8):622-8. [QxMD MEDLINE Link].
Kuhn F, Mester V, Morris R. Intraocular foreign bodies. Ocular Trauma: Principles and Practice. New York: Thieme; 2002. 235-263.
Mader TH, Carroll RD, Slade CS, et al. Ocular war injuries of the Iraqi Insurgency, January-September 2004. Ophthalmology. 2006 Jan. 113(1):97-104. [QxMD MEDLINE Link].
Percival SP. A decade of intraocular foreign bodies. Br J Ophthalmol. 1972 Jun. 56(6):454-61. [QxMD MEDLINE Link].
Roper-Hall MJ. Review of 555 cases of intraocular foreign body with special references to prognosis. Br J Ophthalmol. 1954. 38:65-99.
Smiddy WE, Hamburg TR, Kracher GP, et al. Contact lenses for visual rehabilitation after corneal laceration repair. Ophthalmology. 1989 Mar. 96(3):293-8. [QxMD MEDLINE Link].
Sternberg P Jr, de Juan E Jr, Michels RG, et al. Multivariate analysis of prognostic factors in penetrating ocular injuries. Am J Ophthalmol. 1984 Oct 15. 98(4):467-72. [QxMD MEDLINE Link].
Thach AB, Ward TP, Dick JS, et al. Intraocular foreign body injuries during Operation Iraqi Freedom. Ophthalmology. 2005 Oct. 112(10):1829-33. [QxMD MEDLINE Link].
Williams DF, Mieler WF, Abrams GW, et al. Results and prognostic factors in penetrating ocular injuries with retained intraocular foreign bodies. Ophthalmology. 1988 Jul. 95(7):911-6. [QxMD MEDLINE Link].
Williams S, Char DH, Dillon WP, et al. Ferrous intraocular foreign bodies and magnetic resonance imaging. Am J Ophthalmol. 1988 Apr 15. 105(4):398-401. [QxMD MEDLINE Link].
Wong TY, Tielsch JM. A population-based study on the incidence of severe ocular trauma in Singapore. Am J Ophthalmol. 1999 Sep. 128(3):345-51. [QxMD MEDLINE Link].
Zinreich SJ, Miller NR, Aguayo JB, et al. Computed tomographic three-dimensional localization and compositional evaluation of intraocular and orbital foreign bodies. Arch Ophthalmol. 1986 Oct. 104(10):1477-82. [QxMD MEDLINE Link].

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.