Lecture on Intraocular Foreign Bodies For 4th Year MBBS Undergraduate Students By Prof. Dr. Hussain Ahmad Khaqan

1. Intraocular Foreign Bodies
Prof. Dr. Hussain Ahmad Khaqan
 MD
 FRCS(Glasgow)
 FCPS(Ophth.)
 FCPS(Vitreo Retina)
 MHPE (KMU)
 CICO(UK)
 CMT(UOL)
 Fellowship in Medical Retina (LMU, Munich)
 Fellowship in Vitreo Retinal Surgery (LMU, Munich)
 Consultant Ophthalmologist & Retinal Surgeon
Professor of Ophthalmology
Lahore General Hospital, Lahore
Ameer Ud Din Medical College, Lahore
Post Graduate Medical Institute, Lahore
Shaukat Khanum Memorial Cancer Hospital & Research Centre ,Lahore

2. DEFINITION
• Intraocular foreign body (IOFB) injuries vary in
presentation, outcome, and prognosis depending
upon various factors. IOFBs can cause perforating or
penetrating open globe injuries.

3. TYPES CONTINUE…
1. Frequently produce severe inflammatory reactions
and may encapsulate on the retina.
a. Magnetic: Iron, steel and tin.
b. Nonmagnetic: Copper and vegetable matter
(may be severe or mild).

4. 2. Typically produce mild inflammatory reactions.
a. Magnetic: Nickel.
b. Nonmagnetic: Aluminum, mercury, zinc,
vegetable matter (may be severe or mild).
TYPES CONTINUE…

5. 3. Inert foreign bodies:
Carbon, gold, coal, glass, lead, gypsum plaster,
platinum, porcelain, rubber, silver, brass and
stone.
However, even inert foreign bodies can be toxic to the
eye because of a coating or chemical additive.
TYPES

6. SYMPTOMS
1. Eye pain
2. Decreased vision
3. History (e.g., hammering metal or sharp object
entering globe).

7. SIGNS CONTINUE
1. Corneal or scleral perforation site, hole in the iris, or
an IOFB (intraocular foreign body).
2. Microcystic (epithelial) edema of the cornea

8. 3. Siderosis:
Manifesting as anisocoria, heterochromia, corneal
endothelial and epithelial deposits, anterior
subcapsular cataracts, lens dislocation and optic
atrophy.
SIGNS

9. Corneal Intraocular foreign body (IOFB)

13. Metallic Intraocular foreign body.

14. 1. Siderosis
2. Chalcosis
TOXICITY

15. Siderosis (Ferrous Foreign Body)
• Dissociated iron has a predilection for deposition in
epithelial tissue (lens, Retinal pigment epithelium),
causing metabolic toxicity and cellular death.
• RPE (Retinal pigment epithelium) toxicity results in
decreased vision, constricted VF (visual field) and
RAPD (relative afferent pupillary defect)
TOXICITY continue

16. • Clinical features include injection, heterochromia
(iris reddish brown), secondary glaucoma, anterior
capsular cataract, reddish ferrous deposits at lens
epithelium, coarse degenerative pigment dispersion,
retinal detachment.
TOXICITY continue

17. .

18. Chalcosis (Copper Foreign Body)
• Pure copper IOFBs (intraocular foreign bodies) result
in rapid fulminant endophthalmitis.
• Chalcosis results from FB (foreign body) of alloys of
copper (brass, bronze) and mirror the ocular signs of
Wilson’s disease: Kayser–Fleischer ring, anterior
‘sunflower’ cataract, yellow retinal plaques.
TOXICITY continue

19. Figure: A. Kayser–Fleischer ring,
B. Anterior ‘sunflower’ cataract.

20. WORK-UP CONTIUE
1. History: Composition of the foreign body and the
time of last meal.
2. Perform ocular examination, including visual acuity
assessment and careful evaluation of whether the
globe is intact
3. Slit lamp examination

21. 4. Consider gonioscopy of the AC (anterior chamber)
angle
5. Dilated retinal examination using indirect
ophthalmoscopy.
6. Obtain a CT (computed tomography) scan of the
orbits and brain
WORK-UP CONTIUE

22. 7. Gentle B-scan of the globe and orbit
8. Culture the wound site if it appears infected
WORK-UP

24. Figure: B scan showing IOFB.

25. Figure: CT scan (axial view) showing IOFB in left eye

26. TREATMENT CONTINUE..
1. Hospitalization with no food or drink (NPO) until
repair.
2. Place a protective rigid shield over the involved eye.
Do not patch the eye.
3. Tetanus prophylaxis as needed.

27. 4. Broad spectrum gram-positive and gram-negative
antibiotic coverage.
5. Cycloplegia (e.g., atropine 1% b.i.d.) for posterior-
segment foreign bodies.
TREATMENT CONTINUE..

28. 6. Urgent removal of any acute IOFB (intraocular
foreign body) is advisable to reduce the risk of
infection.
TREATMENT CONTINUE..

29. IOFB Removal
AC IOFB Comeal approach ; removal with fine forceps
Angle IOFB Scleral trapdoor approach
Lenticular IOFB Remove along with cataract surgery
Ciliary body IOFB Cannot be directly visualized so consider using
an electroacoustic locator and removal through
scleral trapdoor approach
Posterior segment IOFB IOFB removal should be undertaken as soon as
optimal surgical expertise and operating room
conditions are available. Use an intraocular
magnet or vitrectomy forceps
IOFB=Intraocular foreign body, AC=Anterior chamber.
TREATMENT

30. THANK YOU