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[VR] Intraocular Foreign Body - Step by Step Management

Reactive materials:

  • Iron –> siderosis

  • Copper –> chalcosis

  • Nickel (severe inflammation)

  • Mercury –> phthisis bulbi (rapid)

  • Zinc (minimal inflammation)

  • Aluminium (minimal inflammation)

Inert materials:

  • Plastic

  • Glass

  • Sand

  • Stone

Stepwise apporach to Open Globe Injury (OGI) with IOFB:

  1. Systematic evaluation – rule out any life-threatening injuries

  2. History – aetiology, type of material, time of injury, last meal and allergies

  3. Examination – VA, RAPD, dilated fundal exam (IOFB, RD).

  4. B-scan but very gentle if necessary

  5. Broad spectrum antibiotics (eg. oral ciprofloxacin 750mg BD) & tetanus jab.

  6. CT scan – intracranial FB or fracture.

  7. Thorough consultation consent process with patient.

  8. OGI with IOFB – decide whether to combine both or repair OGI first.

  9. Consider intravitreal antibiotics + vitreous biopsy for post-traumatic endophthalmitis.

  10. If traumatic cataract – pars plana lensectomy then left aphakic for secondary IOL 3-6 months later.

  11. PPV – core PPV –> PVD induction important to prevent iatrogenic breaks during removal of IOFB.

  12. Removal of IOFB – IOFB endomagnet (1 mm size) / basket forceps (1-3mm) / diamond-coated FB forceps (3-5mm) / scleral tunnel or limbal incision (> 5mm).

  13. Use silicone oil for severe cases to prevent PVR. Otherwise, can use other tamponades depending on findings.

  14. Monitor cornea – easily oedema during surgery if damaged.

  15. 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%).

Recommended reference:

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