Retinal Physician

JAN-FEB 2017

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48 R E T I N A L P H Y S I C I A N . C O M | J A N U A R Y / F E B R U A R Y 2 0 1 7 Update on the Management of Intraocular Foreign Bodies Patients with IOFBs should be closely monitored for possible post-traumatic complications, including retinal detachment and cataracts. A JAY E. KURIYAN, MD • ALEKSANDRA V. RACHITSKAYA, MD I ntraocular foreign body (IOFB) cases are challenging and can have variable visual outcomes. e clinical his- tory, physical exam, and imaging are helpful in planning the surgical approach for patients with IOFBs. EPIDEMIOLOGY Between 20,000 and 68,000 serious vision-threatening ocu- lar injuries occur in the United States every year. 1,2 IOFBs are found in 8% to 25% of all open globe injuries (OGIs). 3 Most IOFB patients are male, and most are between 21 and 40 years old. 2 e most common location of injury is the work- place. 2 IOFB FEATURES Metallic IOFBs are by far most common, followed by organic material and nonmetallic inorganic material. 2,4 In terms of management, glass IOFBs, which account for 6% to 9% of all IOFBs, can be observed if there is no other significant struc- tural damage. Retained metallic IOFBs, on the other hand, can result in chalcosis and siderosis with retinal toxicity; they most often require removal. LOCATION OF IOFBS An IOFB can be associated with penetrating or perforat- ing injury and can involve the anterior chamber (Figure 1), crystalline lens, posterior chamber, and even the orbit if a posterior exit wound is present. e different locations of the IOFB are important for the surgical approach. e loca- tion may also be important to the visual prognosis. One study found that posterior segment IOFBs are more likely to be associated with no-light-perception vision than anterior seg- ment IOFBs. 5 PATIENTS WITH IOFBS: EVALUATION History A thorough history is essential when evaluating a patient with an IOFB. e details about how the injury occurred, the use of protective eye wear, the time from injury to presen- tation, visual/ocular symptoms, and prior treatments should be obtained. e location of the injury (eg, work) and cir- cumstances of the injury (eg, assault) are especially important items to document due to potential legal ramifications. Findings of systemic involvement, such as loss of con- sciousness or concurrent bodily injuries associated with the trauma, should be managed with the assistance of other spe- cialties if necessary. Prior ocular history and surgeries need to be obtained from the patient because the ability to complete a full exam is sometimes limited by the injury (eg, hyphema), Ajay E. Kuriyan, MD, Flaum Eye Institute, University of Rochester Medical Center, 601 Elmwood Ave., Box 659, Rochester, NY 14642 Aleksandra V. Rachitskaya, MD, Cole Eye Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue/i32, Cleveland, OH 44106, rachita@ Disclosures: AEK: Allergan (consultant), Bayer Healthcare (grant support); AVR: Allergan (consultant). Figure 1. Intraocular foreign body through the cornea and into the anterior chamber. R E T I N A L P H Y S I C I A N | J A N U A R Y / F E B R U A R Y 2 0 1 7 48

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