Surgical management of a white cataract induced by a metallic intralenticular foreign body

Introduction: A patient with an intralenticular metal foreign body in the right eye who, following initial antibiotic treatment for a corneal wound, developed a traumatic cataract a month after the initial event. Patient and clinical findings: Upon presentation, the clinical examination of the patient showed just a small corneal leucoma, no signs of inflammation in the anterior segment, and a white cataract. Diagnosis, intervention, and outcomes: Ultrasound B-scan and orbital computed tomography were performed, which suggested the presence of a metallic foreign body in the crystalline lens. The surgical management of the case, where, given the integrity of the posterior capsule and verified intraoperatively, a triple procedure was performed, with foreign body extraction, phacoemulsification, and IOL implantation, resulting in a good visual outcome. Conclusions: Metallic intralenticular foreign bodies represent a rare finding that sometimes goes unnoticed in the clinical examination, but which can lead to serious sight-threatening complications and should therefore not be underestimated. When a foreign body sensation is referred, an accurate examination of the anterior segment is necessary. The surgery required in case of complications can be challenging and demands attentive preoperative evaluation and readiness to adapt to conditions found intraoperatively.