Intraocular Foreign Body

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.

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

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.


Management:

• 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.