Appendix
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Ophthalmology

Intraocular Foreign Body

Intraocular foreign body (IOFB) is an accidental injury usually resulting from chisel hammering and firearm use. It is a serious ocular condition that can potentially cause permanent vision loss. To avoid the high morbidity associated with this condition, it must be promptly diagnosed and treated. This activity reviews the evaluation and treatment of an IOFB and highlights the role of the interprofessional team in evaluating and treating patients with this condition. Objectives: Explain the path

v1 · Reviewed Nov 7, 2026 by Automated Clinical Reviewer (Strict Verbatim v1)
  • It is a serious ocular condition that can potentially cause permanent vision loss.
  • To avoid the high morbidity associated with this condition, it must be promptly diagnosed and treated.
  • IOFB associated ocular trauma is unique and requires skillful investigation with early treatment.
  • Prompt referral to an ophthalmologist is necessary.
  • A detailed history is essential to know about the mechanism of injury and the nature of the foreign body.
  • A careful history that something hit the eye often reveals the diagnosis of an IOFB.
  • A meticulous examination is very important.
  • Presenting and best-corrected visual acuity should be recorded.
  • Slit-lamp examination is a must.
  • A Seidel test should be performed.
  • Dilated fundus examination is essential.
  • In cases of media haze due to cataracts, vitreous hemorrhage, or endophthalmitis, the USG (ultrasonogram) B scan is done to locate the foreign body and measure the size.
  • X-ray of orbits (anteroposterior and lateral view) can detect metallic foreign bodies but cannot detect radiolucent objects like wood or glass.
  • USG B scan is a cheap and useful investigation to detect metallic foreign bodies.
  • CT (computed tomography) scan can accurately detect the number, size, shape, and location of a foreign body.
  • MRI (magnetic resonance imaging) can detect organic and glass objects with greater sensitivity.
  • The full-field electroretinogram (ERG) is done to know the status of the photoreceptors' function.
Ocular Trauma Score (OTS)
The variables used in the OTS are initial vision, globe rupture, perforating injury, retinal detachment (RD), endophthalmitis, and afferent pupillary defect (APD). Each variable is given a score. The initial vision of NPL is given 60 points. Other scores include PL (perception of light)/HM (hand movements)- 70, 1/200 to 19/200- 80, 20/200 to 20/50- 90 and >=20/40- 100 points. Assigned scores for various various features include globe rupture- -23, endophthalmitis- -17, perforating injury- -14, RD- -11, and APD- -10 points. All six scores are added to get a raw score. The conversion of raw scores into the OTS may predict the probability of final vision.
  • The injured eye should be protected with a shield.
  • External pressure should be avoided as it may expel the intraocular contents.
  • Tetanus toxoid (intramuscular) injection should be given.
  • The contaminated part should be cleaned with a sterile solution, and small superficial foreign bodies should be removed in the absence of an open globe.
  • Broad-spectrum intravenous antibiotics may be considered as prophylaxis against endophthalmitis.
  • Iron and copper foreign bodies should be removed as soon as possible as they are highly reactive.
  • The first step is the primary repair of the ocular coats (cornea and/or sclera) of the open globe.
  • Meticulous closure of the perforation site is done first.
Tetanus toxoid
intramuscular
Adult
Not specified in source
Renal
Not specified in source
Duration
Not specified in source
  • MRI is contraindicated in the metallic foreign body as it can dislodge it and cause further damage.
  • USG B scan should be avoided in an open globe as the pressure from the ultrasonic probe may further increase the damage and may cause extrusion of ocular contents.
  • As it requires contact, it should be avoided in open globe injuries.
  • If the IOFB is large, it is better to remove it through the anterior route through a corneoscleral tunnel.
  • A large IOFB requires a large pars plana incision which increases the chances of retinal incarceration, vitreous prolapse, and retinal detachment.
  • The prognosis of an IOFB depends upon multiple factors.
  • Patients presenting late develop siderosis (in case of iron foreign body/bodies) and have a poor prognosis.
  • The presence of an afferent pupillary defect, hyphema, vitreous hemorrhage, retinal detachment, proliferative vitreoretinopathy, or endophthalmitis has a bad visual outcome.
  • The incidence of infectious endophthalmitis has been reported in 7 to 13% of IOFB cases.
  • A delay in managing more than 24 hours is associated with an increased risk of infectious endophthalmitis.
  • The risk of phthisis should be explained in IOFB cases.
  • The patients should be adequately counseled regarding the prognosis of IOFB and the importance of long-term follow-up.
  • These patients can then be followed by their primary clinicians, and they should ensure compliance with treatment.
  • review
    Intraocular Foreign Body. StatPearls [Internet] — Abhishek Gupta, Koushik Tripathy — StatPearls Publishing, 2023

Decision support only. Verify against local protocols and current labeling. Source: www.ncbi.nlm.nih.gov