Intraocular foreign bodies : A major public health problem

Introduction: Intraocular foreign bodies are a major public health problem due to their frequency, their severity and their difficult and costly management. They mainly affect young men in the midst of professional activity and have serious social and medico-legal consequences.

Case presentation: We report the case of a 34-year-old patient, who suffered a contusive eye trauma with palpebral tearing of the left eye by barbed wire. The initial ophthalmologic examination found a preserved visual acuity, a transfixing eyelid injury with skin substance loss, a temporal conjunctival injury with hemorrhage and resulting from orbital fat. An orbital x-ray showed the radiopaque foreign bodies with no orbital fracture. The oculo-orbital CT scan xas normal. The V3M fundus revealed, on the postoperative day, a small pre-retinal brownish formation, measuring 0.2 mm, located ½ papillary diameter from the center of  the  fovea,  without  retinal  alteration  in  front  of,  and  without  peripheral  retinal  lesions.  Optical coherence tomography (OCT) showed a small hyperdense infra-millimeter formation, a retinal invasion limited to the fiber optic layer with posterior shadow cone. The patient was put on corticosteroid and antibiotic therapy. Regarding the foreign body, the decision to abstain from treatment has been taken. Discussion: The decision to remove a missed retained intraocular foreign body is complex and depends on multiple factors, including surgical difficulty and the composition, size, and location of the retained foreign body. Removal should be weighed against the possible serious complications of intraocular surgery. If removal is surgically difficult, or the retained material is inert, patients can be managed conservatively with regular monitoring, as in our case.

Conclusion: Any traumatic  element  should  be  investigated  to  search  an  intraocular  foreign  body,  by  a  careful examination, even if imaging is normal. The indications to operate in emergency are well codified.