Current trends in the management of intraocular foreign bodies

Abstract

The aim of this article is to present the recent literature on the preoperative assessment, intraoperative management and postoperative care of patients with intraocular foreign bodies and present a management algorithm. The preoperative assessment includes an evaluation of concomitant, potentially life-threatening conditions, as well as a relevant history and ophthalmic examination. Neuroimaging, preferably with noncontrast helical computed tomography, provides excellent information about intraocular foreign body size, shape and location. The preoperative assessment provides valuable information for prognosis, counseling, and intraoperative guidance. The decision of delayed versus immediate intraocular foreign body removal must be guided by the patient's medical status, availability of adequate operating facilities and staff, and the presence of clinical endophthalmitis. The administration of perioperative systemic and topical third or fourth-generation fluoroquinolones may play a role in decreasing the incidence of postoperative endophthalmitis. Intravitreal antibiotics warrant consideration in patients with a Gram stain positive for organisms, in cases suspicious for endophthalmitis, and in high-risk settings. Both the material and size of the foreign body are considerations in the choice of instrument and extraction site used (sclerotomy versus scleral tunnel) at time of pars plana vitrectomy and intraocular foreign body removal. Postoperatively, patients should be monitored closely for the development of endophthalmitis, retinal detachment and proliferative vitreoretinopathy. This review summarizes the recent literature on the assessment of intraocular foreign bodies and techniques for their removal. An algorithm provides guidelines for their perioperative and operative management.