Managing intraocular foreign bodies: Injury to intervention

Background: Among ocular injuries, corneal foreign bodies (FBs) are the most reported in clinical practice. Superficial FBs are easily visualized using slit-lamp biomicroscopy and can often be removed immediately as an outpatient procedure. [1] In children and uncooperative patients where the exact location and depth cannot be commented on slit-lamp examination, anterior segment optical coherence tomography (AS-OCT) plays a critical role in evaluating FB depth, location, and possibility of Descemet’s membrane (DM) breach. [2] Purpose: A depth-based surgical technique facilitates precise management, maintaining corneal structural integrity and reducing the likelihood of postoperative complications. Synopsis: This video explores the clinical challenges associated with the removal of various intraocular foreign bodies via the anterior approach. Through case-based clinical scenarios, it illustrates depth-based surgical planning and various FB removal techniques and highlights the role of AS-OCT in guiding surgical decisions. Postoperative outcomes are also discussed, emphasizing the importance of precise preoperative assessment and technique selection. Highlights: This video highlights a detailed overview of various intraocular FB (IOFB) management techniques, emphasizing individualized approaches based on FB characteristics and tissue response. Organic FBs pose a high risk of infection and necessitate prompt removal. In contrast, inert materials are usually well tolerated, while metallic FBs can trigger inflammation and require vigilant follow-up. [3] AS-OCT plays a vital role in surgical planning by delineating entry tracts and evaluating the integrity of DM. [2,4] Superficial FBs limited to the anterior stroma are typically removed externally. However, when an FB breaches the DM, removal via the anterior chamber using long vitreoretinal forceps is preferred. [5] This internal approach provides better surgical access, preserves corneal architecture, and minimizes the risk of enlarging the entry tract or inducing astigmatism. Video Link: https://youtu.be/SBH0Aa9kj7c