Clinical 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.
- 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.