An Occult Intraocular Foreign Body – Where Is It?

To illustrate the case of a metal scrap cutter with a suspected intralenticular foreign body

 

A government hospital in Delhi, India

A 22 year old metal scrap cutter presented to the emergency with a diminution of vision after injury to his left eye while working. Examination findings included a self--sealed corneal perforation, a shallow anterior chamber and a post traumatic intumescent cataract with posterior synechiae in 3 quadrants and bunched up iris tissue. An emergency NCCT orbit revealed a hyperdense foci anterior to the lens, suggestive of a foreign body - however, its precise site, whether it was in the lens, iris or in the angles, was not clear due to dense adhesions between all three. An ASOCT was unable to help, but ultrasound biomicroscopy pointed to an intra-lenticular location. He was taken for urgent surgery, and careful exploration with synechiolysis and iris hooks revealed a 2x2 mm metallic foreign body stuck to the anterior capsule of the lens. Cataract extraction by lens aspiration showed a large posterior capsular breach, and an anterior chamber IOL was put, with good gain of vision post operatively.

Ultrasound biomicroscopy and ultimately surgical exploration is of utmost importance when an intralenticular foreign body is suspected.