|Year : 1980 | Volume
| Issue : 3 | Page : 145-149
Intralenticular foreign bodies
SK Angra, Madan Mohan
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All-India Institute of Medical Sciences,New Delhi, India
S K Angra
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, A.I.I.M.S , New Delhi-29
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Angra S K, Mohan M. Intralenticular foreign bodies. Indian J Ophthalmol 1980;28:145-9
Intralenticular foreign bodies constitute about 10 % of intraocular foreign bodies. Various types of foreign bodies in the lens have been reported like glass, eye lash,, Coal6 and iron,,,, There have always been problems about their diagnosis and management.
An attempt has been made to highlight the difficulties with intralenticular foreign bodies as regards their diagnosis as well as management.
| Materials and observations|| |
Six cases of foreign body in the lens were investigated clinically, radiologically and by ultrasonography and were managed [Table - 1]. The cataractous lenses were aspirated by method of Angra
| Discussion|| |
The prevalence of intralenticular foreign bodies in rare. The entry of the foreign body in the eye may be active when this is a primary process while it may be a passive process when foreign body like cilia enter the lens.
It is well recognised that apparently localised cataract may gradually progress to a complete cataract which will hinder the diagnosis of foreign body in the lens. The size, shape and chemical nature of foreign body play an important role in this process of opacification of the lens. Thus, the early the lens is examined for foreign body or its effects, the better it is. Biomicroscopy is essential and lens is to be scanned throughout its depth to find the foreign body [Figure - 1] In our cases, the foreign body has been seen lodged in the anterior half of the lens, between the lens nucleus and cortex in 2 out of 3 cases having visible foreign bodies because nucleus puts a resistance to its penetration. Only in one case it was seen near the posterior capsule [Figure - 1].
The diagnosis of intralenticular foreign bodies is often missed by radiological and even by ultrasonography, as seen in majority of our cases. The small to medium foreign bodies may occasionally be broken down sufficiently to elude roentgenographic and ultrasonographic detection. Only in one case we could localise the foreign body by a radiograph [Figure - 2] In four of our cases it was the brown pigment deposits in the lens that helped to clinch clinically the diagnosis of iron foreign bodies. This iron pigment initially is localised subcapsularly but later becomes diffuse [Figure - 3]. This observation is in conformity with that of Keeny
The dangers of intralenticular foreign bodies are alarming though occasionally a clear Ions may remain for many years (Sedan). It is generally recommended that all iron foreign bodies be removed as early as possible to avoid siderosis bulbi. In intralenticular iron foreign bodies there can be direct siderosis around the foreign body and indirect siderosis inside the lens involving capsule and lens epithelium which helps in the diagnosis in majority of cases. The generalised siderosis from intralenticular foreign body is rare but has been in our case No. 1 showing the ERG and EOG changes too. Thus there should not be delay in the removal of iron foreign bodies.
Intracapsular lens extraction is not always possible to accomplish, depending on the age of the patient. It is best in these cases to remove the foreign body, if magnetic, with hand magnet and lens material be aspirated. If nonmagnetic, the aspiration of foreign body under microscope is preferred.
If the damage to the lens is localised, cataractous change and foreign body being innert and nonmagnetic, the best policy is to wait and let it remain in situ.
There is no single opinion whether the cilia in the lens be removed or not because cilium retained in the lens may not cause any reaction and may remain clear for years together (Von Hippel and Byrnes). In such circumstances no surgical interference is called k for. But intralenticular incarceration of the cilia, causing severe reaction and cataract, as was present in our case, calls for the removal of cilia and that of cataractous lens, after control of inflammation [Figure - 4].
| Summary|| |
The problems in diagnosis and management of intralenticular foreign bodies are presented.
| References|| |
Ropper Hall, M.J., 1959, TOSUK, 79:57.
Forest, 1955, Bull. Soc. Ophthalmol. Fr. 3:196.
Von, Hippel, 1927, Ber. dtsch. Ophthalmol. Ges. 46:408.
Sedan, I., 1950, Bull. Soc. Ophthalmol. Fr. 822.
Byrnes, 1949, Amer. Jour. Ophthalmol. 32:847.
Castroviejo, R., 1931, Amer. Jour. Ophthalmol. 14:537.
Chance, B., 1933, Amer. Jour. Ophthalmol. 16: 597.
Chisholm, I.A., 1964, Brit. Jour. Ophthalmol.48: 364.
Galin, M, and Taylor M, 1961, Arch. Ophthalmol. 66:830.
Keeny. A., 1971. Arch. Ophthalmol. 86:499.
Angra, S.K., 1976, Proc. 6th. Congress Asia Pacific Acad. Ophthalmol. held at Bali, Indonesia p. 337.
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]
[Table - 1]