[VR] Intraocular Foreign Body - Step by Step Management
Iron –> siderosis
Copper –> chalcosis
Nickel (severe inflammation)
Mercury –> phthisis bulbi (rapid)
Zinc (minimal inflammation)
Aluminium (minimal inflammation)
Stepwise apporach to Open Globe Injury (OGI) with IOFB:
Systematic evaluation – rule out any life-threatening injuries
History – aetiology, type of material, time of injury, last meal and allergies
Examination – VA, RAPD, dilated fundal exam (IOFB, RD).
B-scan but very gentle if necessary
Broad spectrum antibiotics (eg. oral ciprofloxacin 750mg BD) & tetanus jab.
CT scan – intracranial FB or fracture.
Thorough consultation consent process with patient.
OGI with IOFB – decide whether to combine both or repair OGI first.
Consider intravitreal antibiotics + vitreous biopsy for post-traumatic endophthalmitis.
If traumatic cataract – pars plana lensectomy then left aphakic for secondary IOL 3-6 months later.
PPV – core PPV –> PVD induction important to prevent iatrogenic breaks during removal of IOFB.
Removal of IOFB – IOFB endomagnet (1 mm size) / basket forceps (1-3mm) / diamond-coated FB forceps (3-5mm) / scleral tunnel or limbal incision (> 5mm).
Use silicone oil for severe cases to prevent PVR. Otherwise, can use other tamponades depending on findings.
Monitor cornea – easily oedema during surgery if damaged.
Scleral buckle – usually encirclement (depending on surgeon preference and case)
Prognosis – poor if develop suprachoroidal haemorrhage (around 5%), PVR (around 10%) or endophthalmitis (average 5%).