|Year : 1984 | Volume
| Issue : 5 | Page : 289-292
Peforating ocular injuries with retained intra-ocular foreign bodies
SP Dhir, Kanwar Mohan, VP Munjal, IS Jain
Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
S P Dhir
Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh-160 012
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Dhir S P, Mohan K, Munjal V P, Jain I S. Peforating ocular injuries with retained intra-ocular foreign bodies. Indian J Ophthalmol 1984;32:289-92
|How to cite this URL:|
Dhir S P, Mohan K, Munjal V P, Jain I S. Peforating ocular injuries with retained intra-ocular foreign bodies. Indian J Ophthalmol [serial online] 1984 [cited 2022 Sep 27];32:289-92. Available from: https://www.ijo.in/text.asp?1984/32/5/289/27494
Herein we present a study of 94 eyes with perforating ocular injuries with retained intra-ocular foreign bodies to highlight the various factors which govern final visual outcome.
| Material and methods|| |
Ninety patients who presented with perforating ocular injury with retained intraocular foreign bodies were studied. Mode of injury and nature of the foreign body whether metallic or non-metallic, magnetic or nonmagnetic were noted. Detailed ocular examination was carried out and wound of entry of foreign body and injuries to various ocular structures were recorded. Foreign body localisation was done by applying limbal ring. Magnetic foreign bodies which lodged in the posterior segment of the eye were removed by electromagnet through pars plana approach and those in the anterior segment were removed through anterior approach. In some eyes with large corneal or corneoscleral - perforations, foreign bodies were removed through the perforation site prior to suturing No attempt was made to remove nonmagnetic and non-metallic foreign bodies. Patients were followed up for a period varying from 1 month to 3.5 years (average 6 months). The eyes subjected to foreign body removal had an average follow up of 8 months.
| Observations|| |
All but one patient were males. Fifty nine of the 90 patients. (65.56%) were in 3rd to 4th decade. There was no predilection for the either eye and in four patients (4.44%) both eyes were injured. The use of hammer and chisel was responsible for intraocular foreign bodies in 55 patients (61.11%) followed by working on power driven machines and tools in 22 patients (24.44%). The other modes of injury were, dynamite blast in nine patients, gun shots in three patients and glass bottle in one patient. The time interval between infliction of injury and reporting ranged from few hours to two years. 60% of the patients presented within one week and another 18.88% within one month of trauma.
The wound of entry of foreign body was corneal in 63 eyes (67.02%), scleral in 24 eyes (25.53%) and corneaoscleral in seven eyes (7.45%). Twelve eyes required wound repair out of which nine eyes also required abscision of prolapsed uveal tissue. Thirteen of the 94 eyes (13.83%) had frank intra-ocular infection and were excised. Lens was injured in 69.15% of the eyes and 45.74% of eyes had uveitis at the time of presentation [Table - 1]. Five patients who presented late (One month to two years) and had retained iron foreign body had signs of siderosis bulbi. Three eyes (3.2%) had retinal detachment at the time of presentation after about three months of trauma.
The foreign bodies were metallic in 80 eyes (75 magnetic) and non metallic in 14 eyes. Size of the foreign bodies varied from two to six mm. The retained intra-ocular foreign bodies were in posterior segment in 74 eyes in the anterior segment in 20 eyes.
Foreign body removal was not attempted in ten out of 75 eyes with magnetic foreign bodies because of frank intra-ocular infection. Of the remaining 65 eyes, foreign body removal was tried through pars plana in 58 eyes and through corneal/corneoscleral tear or corneal section in seven eyes. The foreign bodies could be successfully removed in 60 out of 65 eyes (92.3%) and the attempt failed in five eyes (7.7%) where foreign body was suspected to be impacted. Vitreous haemorrhage occurred in two eyes following foreign body removal and ten eyes (15.38%) developed retinal detachment after an average period of four months of foreign body removal. Cataract surgery was done in seventeen eyes and retinal detachment surgery in two eyes.
The final outcome in 60 eyes following removal of foreign body is detailed in [Table - 2]. The average follow up was 8 months. Only 10% had useful vision (6/60-6/24) and 25% achieved good vision (6/18-6/6). Out of other 34 eyes only three eyes had useful vision and three achieved good vision. [Table - 3][Table - 4][Table - 5] summarise the final visual.
[Table - 3][Table - 4][Table - 5] summarise the final visual outcome in relation to would of entry, site of retained foreign body and type of foreign body respectively.
| Discussion|| |
Perforating injuries of the globe with retained intraocular foreign bodies most frequently result from occupational activities and hence predominantly involve males in 3rd to 4th decade. The use of hammer and chisel was by and large the major cause in our patients and 10% of our cases resulted from dynamite blast. We did not see predominant involvement of left eye as found generally.' A more common corneal wound of entry in our patients is understandable because of its exposed situation. Metallic foreign bodies were mostly lodged in the posterior segment and non-metallic in the anterior segment, 94% of the metallic foreign bodies were magnetic. Incidence of vitreous haemorrhage and uveitis in our patients is comparable to that reported in literature. However, we had a higher incidence of cataract which may perhaps be due to corneal wound of entry of foreign body in majority of them. A much higher incidence of intra-ocular infection in ourpatients is against the usual consensus. 2 A fairly good idea about the position of foreign body could be obtained by limbal ring. In view of more common occurrance of retinal detachment and vitreous haemorrhage by direct approach,' pars plana approach was preferred for the removal of foreign bodies,, in the posterior segment. Though foreign bodies could be removed successfully in 92% of eyes in which attempt was made the visual outcome was not that favourable; only 25% achieved a visual acuity of 6/18 or better and 10% had vision of 6/60-6/24.
The various factors which were found to affect the ultimate prognosis are:
Mode of lnjury: Intra-ocular infection was seen twice more common with hammer and chisel injury than machining.
Wound of entry of foreign body.- Eyes with corneal wound had better visual prognosis than scleral because of relatively less trauma to the posterior segment due to sufficient barrier offered by the lens.
Site of retained infra-ocular foreign body: Eyes
with foreign bodies in the posterior segment had relatively poor visual prognosis than those in the anterior segment because of problem in their removal and more trauma to th c ocular structures.
Type of foreign body: Non-magnetic and impacted magnetic foreign bodies generally entail a worse prognosis because of difficulty in their extraction and none such eye achieved useful vision in our patients. The visual outcome seems better in eyes with blast injury because of damage being limited mainly to the anterior segment in addition to inert nature ofthe entering particles. 48.45% of eyes with blast injury in our ,tudy had useful vision versus 40% in a series by Treister, G.
In general. the ultimate prognosis of eyes with retained intra-ocular foreign bodies is gloomy. Hence prophylaxis needs more stress and prophylactic measures need to be strictly enforced in industrial workers.
| Summary|| |
An analysis of 94 eyes with perforating ocular injuries with retained intra-ocular foreign bodies is presented. The use of hammer and chisel was the commonest mode of injury. 85% of intra-ocular foreign bodies were metallic of Which about 94% were magnetic. The commonest wound off entry of foreign body was corneal. About 79% of eyes had foreign bodies lodged in the posterior segment. Magnetic foreign bodies could successfully be removed in 92% of eyes and 35% of these eyes had favourable visual outcome. Various factors governing ultimate prognosis are highlighted.
| References|| |
Sorsby A., 1972. Modern Ophthalmology, Butter worths, London, 2nd Edition, Vol. 3, pp. 457.
Duke Elder S., 1972. System of Ophthalmology, Honry lCimpton,•London, Vol. 14, Pt. 1, pp. 477.
Treister G.,1969. Amer. J. Ophthalmol. 68: 669.
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5]