Traumatic intraocular foreign bodies: correlation between size and structural damage

Background Ophthalmic trauma caused by intraocular foreign bodies (IOFBs) can impact visual prognosis by generating direct ocular structural damage. Factors bearing poor visual prognosis are related to size and velocity of IOFB, location in posterior segment with associated retinal detachment or endophthalmitis. Current study is aimed to evaluate size and location of IOFB and associated ocular structural damage. Methods In this retrospective study done at single tertiary center, patients injured by IOFBs were analyzed between January, 2010 to January, 2021 for ocular structural damage caused by size, velocity and location of impacted IOFB. All were assessed for corneal or scleral perforation and other structural damage due to IOFB. Location, route of retrieval and size of IOFB was measured. Results All 41 eyes were operated for removal of metallic IOFB. Corneal repair was done in 90.2% and scleral repair in 9.8% eyes. Hyphema cleared in 53.6% eyes. Traumatic cataract in 85.4% requiring phacoemulsification, preexisting aphakia (previous surgery) and siderosis was seen in 2.4% eyes. Retinal detachment was present in 14.6% and endophthalmitis in 4.9% eyes. Location of IOFB was on iris and lens in 2.4% each, with 19.5% impacted in retina and 75.6% were isolated in vitreous cavity. Small size IOFB was 58.3%, medium size was 29.3%, large size was 4.9% and very large size was 7.3%. No eye was deformed requiring evisceration of enucleation. Corneal or scleral repair, phacoemulsification, pars plana vitrectomy and intraocular foreign body removal as one stage procedure was done in each case. Intraocular lens implantation was done where sufficient anterior or posterior capsule was present. Conclusion Trauma caused by IOFB is commonly seen at workplace in young male laborers. It usually presents as corneal or scleral perforation, traumatic cataract, endophthalmitis and retinal detachment. Level of structural damage to ocular structures is dependent on the size, velocity and location of IOFB impaction. One stage surgical intervention for wound closure and IOFB should be considered for better surgical prognosis.