Occult nonmetallic intraocular foreign body: A case report

Introduction Eye injuries are the leading cause of monocular blindness in children. Male patients outnumber female patients as victims of eye injuries by a ratio of 4:1. The most common causes of open globe injuries were sharp objects such as knives and scissors. Endophthalmitis is reported more in lacerated globes than ruptured globes. An aggressive prophylactic medical therapy protocol should be used in the future for patients at higher risk of developing endophthalmitis. We present a pediatric case of a penetrating globe injury. Case report A 6-month-old child presented to the clinic with pain, epiphora and photophobia in the right eye. She was initially managed with topical steroids, topical antibiotics, cyclopentolate and then referred. During our examination, she was found to have a self-opposed entry wound at the limbus that appeared to be created by a sharp object. An opacified lens was clearly seen on handheld slip lamp examination. On B-scan ultrasonography we could identify a hyper-reflective area that was concerning for a foreign body in close contact with the retina. The patient underwent wound repair with Lensectomy Vitrectomy with Endolaser and subsequent removal of intraocular foreign body with injection of intravitreal antibiotics under General Anesthesia. During the surgery we discovered a small cilium which extended from the sclera, through the retina, and into the vitreous. The patient is now well but still awaiting to get a secondary intraocular lens insertion done. Discussion Intraocular foreign bodies carry a high risk of complications, especially when not detected promptly. OGIs with IOFB involving the posterior segment are associated with higher complication and re-operation rates and worse visual prognosis compared to those involving the anterior segment only. B-scan ultrasonography is frequently ordered in this setting as a first line imaging study but has a suboptimal sensitivity for echo lucent foreign bodies. The majority of evidence in favor of CT as the imaging modality of choice for detection of IOFB comes from reports of metallic or otherwise radio-opaque (glass or stone) foreign bodies. In cases of less radio dense foreign bodies, CT imaging has reduced sensitivity. Conclusion Proper diagnosis and urgent management is crucial for any globe injuries to prevent any further complications like endophthalmitis. Patients should follow a regular follow up schedule to maintain and restore his eye health.