Successful management of an unusual extra-ocular foreign body

A 25 yr old male†, industrial worker by profession, presented to the emergency setting of Government Medical College, Chandigarh, in July 2020, with a rare foreign body impaction. This was after he sustained occupational ocular trauma while cutting iron sheets with a manual work tool machine. He was not wearing any ocular protective gear. Ocular examination revealed impaction of multiple round brass foreign bodies in the right lower lid (Fig. 1A) and closed globe injury to the globe with vitreous haemorrhage and peri-papillary retinal pallor (Fig. 1B). Non-contrast computed tomography orbit showed metallic foreign bodies abutting the globe but not causing globe rupture (Fig. 2A: axial view; Fig. 2B: coronal view; Fig. 2C: sagittal view). The foreign bodies were removed (Fig. 1. inset) and the lid and canalicular repair was done. Pars plana vitrectomy was done to clear the vitreous haemorrhage. During the procedure, fibrogliotic bands with pigmentary alterations and multiple retinal breaks were noticed inferonasally due to coup injury at the site of the impact. Differential diagnoses of chorioretinitis sclopetaria, choroidal rupture and commotio retinae were kept in mind. The breaks in the region of chorioretinitis sclopetaria were lasered using a 532 nm laser. At 12 months of follow up, the visual acuity was 20/40 with attached retina (Fig. 3A and B) and no complaints of epiphora were noted. To the best of our knowledge, the impaction of multiple foreign bodies with stacking in the extra-ocular space has not been reported previously in the spectrum of work-tool related eye injuries. A team approach by oculoplastic and retina surgeons may be required for successful management of complex occupational ocular trauma.

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Fig. 1

(A) Photograph showing three metallic foreign bodies stacked one above the other in the lower eyelid in the medial aspect. (B) Fundus picture showing diffuse retinal opacification around optic disc and the fundus details are masked by overlying vitreous haemorrhage (inset). Photograph showing three (two are stacked together) 15 mm round smooth disc-shaped brass foreign bodies removed from the orbit.

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Fig. 2

Computed tomographic scan showing metallic foreign body in the inferior orbit abutting the globe with intact inferior wall of the orbit (A, axial scan, B, coronal scan, C, sagittal scan).

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Fig. 3

(A) Follow-up facial photograph of the patient showing repaired eyelid after removal of the foreign bodies with puncta well opposed to the globe. (B) Fundus montage of the right eye, after pars plana vitrectomy showing inferonasal chorioretinitis sclopetaria (arrow) with laser done for retinal breaks (arrowheads).

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