Metallic Foreign Body Embedded in the Posterior Lens Capsule Helen R. Moreira, MD; Michele S. Todman, MD; Paul J. Botelho, MD Division of Ophthalmology, Rhode Island Hospital, Providence, RI Alpert Medical School, Brown University The authors have no financial interest in the subject matter of this poster.
Purpose • Corneal metallic foreign bodies (CMFBs) are commonly encountered in the emergency room setting associated with high velocity injuries such as grinding, cutting, and hammering of metal.1 In cases of penetrating eye injuries, the incidence of intraocular foreign bodies (IOFBs) is 40% and the incidence of intralenticular foreign bodies is 5-10%.2-4 However, the incidence of concurrent CMFBs and intraocular foreign bodies has never been reported in the literature and is thought to be very low.1 We present a case with concurrent corneal and intralenticular metallic foreign bodies and subsequent management thereof.
Methods • This is a presentation of a case report.
Results • A 31-year-old male presented to the emergency room after a metallic fragment struck his right eye while grinding metal at work. The patient reported wearing protective eyewear at the time of injury. An anterior segment examination was performed in the emergency room and a portion of the metallic foreign body was burred from the right cornea. The patient was sent to the ophthalmology clinic the following day.
Results cont. • Upon examination, the patient's corrected visual acuity was 20/30 OD and 20/25 OS. On slit-lamp exam, a 1 mm x 1 mm corneal epithelial defect from the previous burring procedure was noted along with an adjacent, Seidel negative 1.5 mm x 1.5 mm corneal laceration of the right eye . A 0.2 mm portion of the metallic foreign body remained in the anterior corneal stroma, the intraocular pressure was 16, and 1+ cell and flare were present in the right eye. An iris transillumination defect was seen overlying an apparent IOFB in the posterior lens. The posterior segment examination was unremarkable in both eyes. In addition, the left eye’s anterior segment examination was within normal limits.
Results cont. Figure 1: Iris transillumination defect within the same trajectory path of CMFB
Results cont. • A computed tomography scan confirmed the IOFB. Magnet removal of the foreign body was performed along with phacoemulsification and placement of an intraocular lens in the sulcus, secondary to a posterior capsular break where the IOFB had previously been located . No vitreous prolapse was present, therefore no anterior vitrectomy was performed. Four months post-operatively, the patient’s visual acuity was 20/20 in the right eye with correction.
Results cont. Figure 2: CT image demonstrating the foreign body located in the right posterior lens.
Results cont. Figure 3: Magnet removal of foreign body from the posterior lens.
Conclusion • In cases of penetrating eye injuries, the incidence of IOFBs is 40% and the incidence of intralenticular foreign bodies is 5-10%.2-4 However, the incidence of concomitant superficial CMFBs and IOFBs is unknown and has not previously been reported in the literature. 1 This case emphasizes the need for a high index of suspicion in the setting of high velocity injuries and even a mild reduction in visual acuity. As these injuries can self-seal and give the false impression that full corneal penetration has not occurred. This case also suggests the imperativeness of an Ophthalmology consult for this patient population upon presentation to an emergency room.
References 1. Luo, Z, Gardiner, M. The incidence of intraocular foreign bodies and other intraocular findings in patients with corneal metal foreign bodies. Ophthalmology. 2010;117(11):2218-21. 2. Arora R, Sanga L, Kumar M, Taneja M. Intralenticular foreign bodies: report of eight cases and review of management. Indian J Ophthalmol. 2000;48:119-22. 3. Cazabon S, Dabbs TR. Intralenticular metallic foreign body. J Cataract Refract Surg. 2002;28:2233-4. 4. Coleman DJ, Lucas BC, Rondeau MJ, Chang S. Management of intraocular foreign body. Ophthalmology. 1987;94:1647-53.