Foreign Body in the Anterior Chamber Presenting as Inflammatory Mass on the Iris

A 40-year- old male factory worker presented to our eye clinic with left eye pain, redness and blurring of vision, associated with history of an injury sustained while hammering a nail into the wall three days ago. He had mild symptoms at the onset of the injury. Slit lamp examination of left eye showed a small, self-sealed laceration corneal wound at the temporal limbus and a smooth, well defined, oval mass on the iris in the anterior chamber in the lower temporal quadrant. Rest of the anterior segment and fundus were normal. X-ray orbits showed no intraocular foreign body in the left eye. In view of clinical suspicion, we proceeded with a CT scan of orbits which showed the presence of a small metallic foreign body in the anterior chamber of left eye. After giving topical antibiotic, cycloplegic, and corticosteroid eye drops along with systemic antibiotics for three days, we planned surgical removal of the mass in the anterior chamber. After the mass was removed, we noted a small metallic foreign body embedded within the fibrin mass. The same treatment was continued postoperatively. The left eye became white and quiet, and vision improved to 6/6 with above treatment. The key learning point presented is that when the history is suggestive of intraocular foreign body, even though the X-ray orbits does not show the foreign body one has to get CT scan of orbits done to rule out its presence, especially when there is inflammatory mass in the anterior chamber as seen in our case.

B-SCAN: A SIGNIFICANT TOOL IN EVALUATION OF VARIOUS OCULAR LESIONS AND ITS MERITS OVER CONVENTIONAL OPHTHALMOSCOPIC EXAMINATION

INTRODUCTION: USG study of 118 patients in the present study highlights the advantages of ocular ultra sonography (B-mode) in the evaluation of retinal disorders. AIMS & OBJECTIVES: To evaluate the role of USG in cases with opaque light conducting media where direct vision by ophthalmoscopy is impossible, trauma where direct ophthalmoscopy is challenging even for experienced clinicians and in orbital diseases and in localization of intraocular foreign body. CONCLUSION: Ultrasonographic ndings were well correlated with clinical and operative observations. Sonographic examination unambiguously deserves foremost position in the algorithm for imaging pathological states of the eyeball.

20G Vitrectomy; Current Usage, Indications, and Practices

Vitreoretinal surgery is evolving to a smaller size since first described. After the first vitrectomy probe defined as 17 Gauge (G), a smaller gauge (20G, 23G, 25G, and 27G) vitrectomy probes and trocars were identified. Even though 20G vitrectomy has been used for many years, thinner and less traumatic vitrectomy systems are developed and 20G has lost popularity. Hybrid use of 20G and other systems remains current, especially in cases such as endophthalmitis, intraocular foreign body removal, and cataract surgery complications.

EYES CANNOT SEE WHAT THE BRAIN DOES NOT KNOW

Background: Intraocular foreign body (IOFB) is a common ocular trauma and is a leading cause of visual impairment. Majority of the cases reported the occurrence at the workplace and usually related to activities involving metallic objects. Hammering, drilling, explosion and usage of machining tools are among the causes of IOFB. Foreign body in the angle are frequently missed as it is not visualised directly during a routine examination. Thus, a thorough examination which includes gonioscopy and imaging must be done in all penetrating and full thickness cornea laceration cases. Purpose: We report a case of self-sealed full thickness cornea laceration with presence of metal foreign body in the angle. Method: Case Report Result: A 19 year-old boy, presented with right eye discomfort following trauma 1 week prior to presentation. Examination revealed a self-sealed full thickness cornea laceration at 1-2 o’clock with a foreign body found seated on the angle from gonioscopy. A foreign body consist of metal had successfully removed surgically with the facilitation of intraocular magnet. Conclusion: All self-sealed penetrating injury to the eye required a high index of suspicious of intraocular foreign body. An imaging and complete examination with dilated fundus examination and gonioscopy will be helpful to identify the location of foreign body. Hence, definitive treatment will prevent long term complication related to intraocular foreign body.

Use of Ophthalmic Sonography to Evaluate for Intraocular Foreign Body in Both Outpatient and Emergency Department/Urgent Care Patients

Intraocular foreign bodies (IOFB) present differently depending on the type of material (wood, glass, metal) for the IOFB, extent of the injury, and location of the injury. IOFB and the injury can cause a perforation or penetration of the globe which can require more extensive treatment including surgery. Proper evaluation of the IOFB and injury can help to determine extent of the injury, the prognosis of the vision, and health of the eye before and after treatment but may be difficult for the physician depending on the view of the posterior chamber being compromised by media or simply by patient sensitivity. The extent of the injury may also prevent proper evaluation due to swelling, lacerations on the lids, or pain. Proper ophthalmic sonography can provide a quick evaluation of the globe for any IOFB in both the outpatient setting as well as emergency department setting. Evaluation via sonography may allow the physician to accurately diagnose and properly treat the patient to help restore and prevent further loss of vision.