Intraocular Foreign Bodies—A Review from Entry to Exit and Beyond

Abstract

Ophthalmic trauma, the leading cause of irreversible blindness in young adults, may be associated with obvious or occult intraocular foreign bodies (IOFBs). Critical work-up includes careful history-taking as well as slit-lamp and dilated eye examination. These components are frequently supplemented by imaging tests. Currently, computed tomography is the mainstream modality, offering highly sensitive detection and localization of IOFBs as small as 0.5 mm. IOFBs impact visual prognosis by producing direct damage, causing secondary toxicity, and increasing infectious risk. Factors bearing a poor visual prognosis include large IOFB size, posterior segment location of IOFB, and retinal detachment or endophthalmitis on presentation. Timing of IOFB removal is controversial, but when possible, it is preferable to perform extraction within 24 to 48 hours of initial injury. Antibiotic coverage is also recommended with options of oral alone, intravenous followed by oral, or combination of intravitreal and oral. Even as technology and surgical techniques continue to improve IOFB management, we must still advocate accident prevention to our patients through education and emphasis of protective eyewear.