Ophthalmic case study (Intraocular Foreign Body IOFB)

  Chief complaint:

Severe pain in the right eye.

History of present illness:

A 36-year-old man experienced pain in his right eye immediately after striking a metal object with a metal chisel. He was not wearing safety glasses and felt something hit his right eye. This was followed by tearing and blurred vision. He continued working for a few hours, but when the vision and tearing did not improve, he went to the local emergency room. He was diagnosed with a corneal abrasion and sent home with topical antibiotics. An appointment was scheduled with a local ophthalmologist for the following morning, where it was found that his vision consisted of hand movements, a traumatic cataract had developed, and there was suspicion of an intraocular foreign body (IOFB). He was then referred to the Emergency Ophthalmology Service at the University of Iowa.

Past ocular history: The patient had no previous ocular trauma, disease, or surgery.

Medical history: Uncomplicated.

Medications: Moxifloxacin eye drops.

Family and social history: Non-contributory.

Review of systems: Negative.

Figure 1: Right eye at presentation. Note the traumatic cataract (click on Image for enlargement)

Ocular Examination

Visual acuity:

Right eye (OD): Hand movements

Left eye (OS): 20/20

Intraocular pressure:

OD: 16 mmHg

OS: 17 mmHg

Pupils: Dilated upon arrival by an external ophthalmologist

Anterior and external segment examination (see Figure 1):

OD: Slightly injected conjunctiva, no conjunctival lacerations, no subconjunctival hemorrhage. Cornea with a 1 mm Seidel-negative full-thickness laceration at the center. Formed anterior chamber, 1+ cell, no hypopyon or hyphema. Dense traumatic cataract with rupture of the anterior lens capsule. No view of the anterior vitreous.

Operative system: Normal

Dilated fundus examination (DFE):

OD: No view due to the cataract

Operative system: Normal

Since there was no view of the posterior pole, and we suspected an intraocular foreign body (IOFB) due to the presence of the cataract and the mechanism of injury, an ultrasound of the right eyeball was performed. (Refer to Figure 2)

Diagnosis:

The patient was diagnosed with a corneal laceration, traumatic cataract, and a metallic intraocular foreign body (IOFB).