|Year : 1980 | Volume
| Issue : 3 | Page : 151-154
Intraocular foreign body
RL Agrawal, JMP Agrawal, Shashi Bhasin, CK Nagar
Department of Ophthalmology R.N.T. Medical College, Udaipur, Rajasthan, India
R L Agrawal
Deptt. of Ophthalmology, R.N.T. Medical College Udaipur, Rajasthan
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Agrawal R L, Agrawal J, Bhasin S, Nagar C K. Intraocular foreign body. Indian J Ophthalmol 1980;28:151-4
India being an agricultural country, we often come across the cases of perforating injuries with intraocular foreign body which may lead to partial visual loss to complete blindness. The common type of foreign bodies leading to perforation are thorns, twigs, metallic and non-metallic etc. Out of these twigs and thorns usually lead to perforation causing infection.
The date-palm leaves are used for making brooms and baskets and for fuel. The tip of the leaf is very hard, sharp and pointed resembling to a thorn. Injury caused by date palm leaf is not very common.
The following case report will illustrate an uncommon case of retained intraocular foreign body (date-palm leaf thorn) penetrating obliquely through the coats of eye ball reaching upto the posterior segment with a very different clinical picture.
| Case report|| |
K. 30 years female admitted for watering and redness in left eye with headache off and on for one month. 10 years back she had injury by a date-palm leaf followed by watering redness and mild pain with gradual diminution of vision which remained for 20 days. There after she was asymptomatic but the diminution of vision continued till she became blind. No other history was contributory.
Right eye was normal. Palpebral aperture in left eye was narrow. Palpebral conjunctiva showed multiple patches of conjunctival hypertrophy of 2-3 mm in size, towards lateral canthus. Bulbar conjunctiva showed generalised congestion. At 2 o' clock position 4mm away from limbus a black perforation mark was seen through which some F.B. was projecting [Figure - 1]. Cornea was normal. A.C. depth was normal. It had 4-5 white particles of about 2-3mm size fixed at the lower end near the angle extending from 5 to 8 o'clock position. Iris-pattern was lost. An atrophic white ring seen at pupillary-border. Pupil was central, circular with no reaction to light having aphakia. Intraocular pressure was normal. No perception of light was present. Movements were normal in all directions of gazes. Pupil could not be dilated even by strongest mydriatic but only fundus glow was seen but no details. There were old K.P'.s on back of cornea.
Under local anaesthesia a thorn of date leaf of about 3/4cm. was removed [Figure - 2] with no vitreous disturbance as it was lying obliquely in the coats of eye ball. 3 days after this by a limbal section at lower pole the 3-4 white shining particles were removed. Microscopically the nature of particles could not be detected but on biochemical analysis, the particles were found to be of calcium in nature.
| Discussion|| |
Retention of a foreign body with in the eye which is not very common, causes a great deal of anxiety due to
(a) Mechanical damage caused at the time of accident.
(b) Complications of a perforating ocular injury.
(c) Danger of subsequent development of sympathetic ophthalmitis.
(d) Slow destruction of vision (some time sudden) by chemical changes and also irritable local reaction caused by most foreign bodies in the eye by organic material.
Organic material is rarely met with as an intraocular foreign body. The literature contain few case reports. The common case reports are of splinter of wood, thorn, cotton fibres from clothing etc. after explosions specially in war wounds.
Wood constitute the commonest intraocular foreign body of vegetable nature (some; 6% of all intraocular foreign bodies). We have not found any case report of retained part of date-leaf in coats of eye, reaching upto posterior segment, as a foreign body.
Reaction of posterior segment of the eye is always marked due to organic materials, because these are always unsterile.
Pyogenic infection is usually introduced at the time of injury, leading to the formation of a vitreous abscess and the development of pthisis bulbi. Usually entry of such a foreign body into the eye is through the ciliary region. Diagnosis of such intraocular foreign body is very difficult because radiological investigation is usually negative. If foreign body is extracted in time the prognosis may be good, if not then it can lead to fulminating panophthalmitis or alternatively a less acute endophthalmitis may slowly develop into a condition of pthisis bulbi.
Thete are also reports which have shown a lack of response for several weeks, to a splinter of wood or a thorn are relatively common, but long histories are unusual!
In absence of infection an exudative inflammatory response may lead to a detachment of retina, or a proliferative response resulting in the massive formation of fibrous tissue may appear clinically as pseudoglioma. If by chance the splinter lies between the choroid and retina encapsulation may occur
| Summary|| |
A rare case report of retained organic intraocular F.B. (Date-palm leaf) although leading to complete loss of vision but not causing pthisis bulbi or sympathetic ophthalmitis to second eye though the foreign body entered at the region of ciliary body which is known to be a dangerous zone.
| References|| |
Duke-Elder, S., 1972, System of Ophthalmology, Mechanical Injury Part 1, 545-550, XIV 1972.
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]