Clinical Characteristics, Outcomes, and Complications Associated With Delayed Diagnosis of Intraocular Foreign Body.

Abstract

Purpose: To describe the clinical characteristics, outcomes, and complications in cases of intraocular foreign bodies (IOFBs) when the diagnosis is missed or delayed. Methods: This nonconsecutive case series was a retrospective multicenter study of adult patients with a delayed diagnosis of IOFB, defined as initially presenting elsewhere with a missed diagnosis or a delay of more than 24 hours to seek care. Results: Eighteen eyes were included. The mean (±SD) presenting logMAR visual acuity (VA) was 0.45 ± 0.70 (Snellen equivalent, 20/56). The most common presenting symptom was decreased vision (11 patients [61%]). The general emergency department setting accounted for most initial evaluations (11 patients [61%]); however, 6 patients (33%) were seen in an outpatient setting by an optometrist, ophthalmologist, or both. The most common anatomic locations of the IOFBs were in the iris/anterior chamber (4 [22%]) or lens (4 [22%]) followed by the pars plana/ciliary body (3 [17%]), vitreous (3 [17%]), or retina (3 [17%]). Complications at presentation included endophthalmitis (1 [6%]), retinal detachment (1 [6%]), and retinal tears (4 [22%]). Five patients (28%) had siderosis at presentation. The mean final logMAR VA was 0.13 ± 0.32 (Snellen equivalent, 20/26). At the last follow-up, 15 eyes (83%) had a VA of 20/30 or better. The median follow-up was 139 days (IQR, 86-557). Conclusions: Eyes with a delayed diagnosis of IOFBs often present with good vision and self-sealing wounds. Missed IOFBs can be associated with siderosis, RD, and endophthalmitis. Visual outcomes may be salvaged with prompt treatment.