[Emergency] Atlas of Intraocular Foreign Body

These are pictures of Intraocular Foreign Body. This is a part in OPHTHALMIC TRAUMA of the Atlas of Emergency Medicine book

Clinical Summary

The most important consideration with any eye injury is the possibility of a penetrating globe injury with residual intraocular foreign body (IO FB). Patients may report FB sensation, but subtle presentations occur. A meticulous history about the mechanism of injury (grinding or metal on metal) must be elicited.

Management and Disposition

For suspected subtle injury, a careful examination is required. Bedside ultrasound can be a useful adjunct and allows rapid identification of an IO FB. Care must be taken to avoid any pressure on the globe. A slit-lamp examination with Seidel test (copious amounts of fluorescein instilled and observed for streaming away from the site of perforation) may reveal a microperforation.

Pearls

1. Always maintain a high index of suspicion for penetrating globe injury. Be particularly wary in mechanisms involving use of “metal on metal” such as grinding or  hammering. A positive Seidel test demonstrates corneal microperforation.

2. If ocular penetration is suspected, a diligent search for a retained FB is indicated, beginning carefully with bedside ultrasound using a high-frequency transducer. Computed tomography (CT) is the diagnostic study of choice (avoid magnetic resonance imaging [MRI]) with indeterminate results or when confirmation is desired. 

FIGURE 4.16 ■ Anterior Chamber Foreign Body. A shard from
a nail is seen embedded in the anterior chamber. A “teardrop” pupil
is present, indicating perforation.  

FIGURE 4.17 ■ Seidel Test. A positive Seidel test shows aqueous leaking 

through a corneal perforation while being observed with the slit lamp.  

REFERENCES

The Atlas of Emergency Medicine, Fourth Edition, 2016.