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E. E. Moscato, B. Chen, A. J. Amadi; Clinical and Radiographic Evaluation of Intraocular and Intraorbital Foreign Bodies at a Level I Trauma Tertiary Referral Center. Invest. Ophthalmol. Vis. Sci. 2008;49(13):625.
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To evaluate prevalence of intraocular and intraorbital foreign bodies, identify high risk groups, and consider management outcomes.
Data was obtained for a retrospective case series of all patients diagnosed with an intraocular or intraorbital foreign body (FB) from August 2004 through May 2007. Variables assessed included age, gender, laterality, mechanism of injury, visual acuity (logMAR), presence and location of FB, presence of globe injury, and treatment outcomes. Exclusion criteria included open globes without evidence of FBs, FBs in the preseptal region or sinuses, FBs in the head or brain other than intraorbital or intraocular spaces, and superficial corneal or conjunctival FBs. Hounsfield units were used to correlate clinical findings.
Sixty patients (67 eyes) had intraocular or intraorbital FBs. The mean age was 31.1 years. Ninety-five percent of patients were male. The most common mechanisms of injury were high speed impacts, including gun shot wounds, grinding/hammering, and motor vehicle crashes. Thirty-three percent of eyes had intraocular FBs, 55% had intraorbital FBs, and 12% had both intraocular and intraorbital FBs. The mean VA in the intraocular group was 20/532. The mean VA in the intraorbital group was 20/164, and the mean VA of the intraocular and intraorbital group was 20/17783. In the intraocular subgroup, composition of FBs included 67% metallic, 13% glass, 8% wood, and 12% unknown. Ninety-five percent of patients in the intraocular group underwent primary globe repair, and 5% underwent primary enucleation. Among those with intraorbital FBs, 51% were managed nonsurgically, 24% had removal of the FB, 15% had repair of globe without FB removal, 6% had repair of globe with FB removal, 3% underwent primary enucleation, and 3% underwent primary evisceration. Among eyes with both intraocular and intraorbital FBs, 49% had nonsurgical management, 38% had globe repair, and 13% had primary enucleation with intraorbital FB removal. Among all cases, 4 underwent subsequent enucleations, 4 had concurrent traumatic optic neuropathy, 2 developed endophthalmitis, and 1 developed associated orbital cellulitis.
Findings indicate that almost all patients with intraocular foreign bodies had FB removal, while only one half of those with intraorbital FBs underwent removal. Metallic FBs were the most prevalent. High risk variables included young males, metal workers, and proximity to guns and vehicles. FB composition and speed of impact related to a large range of visual acuities after trauma.
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