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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 9  |  Issue : 2  |  Page : 70-71

Intraocular metallic foreign body ultrasound and computed tomography imaging


Department of Radio-diagnosis, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India

Date of Submission02-Apr-2021
Date of Decision09-Dec-2021
Date of Acceptance29-May-2021
Date of Web Publication26-Dec-2021

Correspondence Address:
Prerna A Patwa
Department of Radio-diagnosis, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha-442 001, Maharashtra.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/dypj.dypj_16_21

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  Abstract 

Orbital foreign bodies are still serious diagnostic problem even after the development of diagnostic imaging techniques. We present an interesting case report of a 42-year-old man who presented with a history of sudden loss of vision after sustaining injury to the left eye due to metallic piece while working. Grayscale ultrasound and computed tomography findings are discussed.

Keywords: Computed tomography orbit, ocular foreign body, ocular trauma, ultrasound


How to cite this article:
Singh RK, Phatak SV, Vaidya SV, Mishra GV, Patwa PA. Intraocular metallic foreign body ultrasound and computed tomography imaging. D Y Patil J Health Sci 2021;9:70-1

How to cite this URL:
Singh RK, Phatak SV, Vaidya SV, Mishra GV, Patwa PA. Intraocular metallic foreign body ultrasound and computed tomography imaging. D Y Patil J Health Sci [serial online] 2021 [cited 2022 Jan 24];9:70-1. Available from: http://www.dypatiljhs.com/text.asp?2021/9/2/70/333765




  Introduction Top


Intraocular foreign body is the ophthalmic emergency which accounts approximately 6% of ocular trauma.[1] Risk factors include being male of the age group of 30–35 years old not wearing eye protection and performing a metal-on-metal task like (hammering or chiseling a metal object). The foreign body most often enters in the cornea and approximately 65% of them land in the posterior segment.[2] Foreign bodies not only cause mechanical damage but also leads to the entry of pathogenic microorganisms into the eyes which further leads to endophthalmitis and it seriously affects the prognosis of visual acuity. Because of these, intraocular foreign body is one of the leading causes of monocular blindness. Longer foreign body stays in the eyes, greater damage they will cause. Because of these reasons, the early diagnosis and treatment of the intraocular foreign body is important. Intraocular foreign body can be classified into metallic foreign bodies and nonmetallic foreign bodies (metals such as iron, copper, and nonmetal foreign bodies such as glasses and wood). Different types of foreign bodies lead to different pathophysiological process. Metallic foreign bodies mainly active metals have severe damage to the eyes within short time because of its toxicity. If metallic foreign bodies are retained for longer periods, it can lead to siderosis or chalcosis which have poor prognosis. Wooden foreign bodies have increased chance of causing endophthalmitis.[3]


  Case Report Top


A 42-year-old male patient presented in the emergency department of Acharya Vinoba Bhave Rural Hospital, Sawangi Meghe with chief complaints of sudden loss of vision with black dots appearing in front of his left eye. He was not wearing safety glasses at the time of work and he felt that something strikes to his left eyeball. On ocular examination, patient’s vision in the left eye was found to be hand motion and in the right eye vision is 6/6. The left eye had circumcorneal and conjunctival congestion with no sub-conjunctival hemorrhage. Fundus examination of the left eye was not possible due to traumatic cataract. The right eye conjunctiva, pupil, anterior chamber, posterior chamber, and fundus examination were normal. Provisional diagnosis of traumatic cataract with the corneal laceration left eye was given. B-scan was advised.

On ultrasonographic B–scan of the left eyeball, a 5.0 mm × 3.0 mm sized hyperechogenic foreign body was present in the posterior segment. No evidence of retinal detachment or vitreous hemorrhage was seen [Figure 1]. Computed tomography (CT) scan was advised for confirmation.
Figure 1: Ultrasound B-scan image of the left eyeball with the high frequency linear probe shows 5 mm sized echogenic metallic foreign body in posterior segment of the eyeball without vitreous haemorrhage

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On CT scan of orbit, imaging was performed using 3 mm slice thickness with contiguous plain axial and coronal scan of orbits was done. A 5.0 mm × 4.0 mm sized well-defined hyperdense foreign body (HU value 1200) producing streak artifacts were seen in the posterior chamber of the left eyeball [Figure 2] and a metallic intraocular foreign body. The findings were confirmed at surgery.
Figure 2: (a) (Right) axial computed tomography orbit shows a well-defied hyperdense foreign body producing streak artifacts in the posterior chamber of the left eyeball. The right eyeball, retro-bulbar area, extra-ocular muscles, and bony orbital wall were normal. (b) (Left) coronal computed tomography orbit shows foreign body producing streak artifacts in posterior chamber of the left eyeball

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  Discussion Top


X-ray examination is a traditional diagnostic method of intraocular foreign body and this method is easy to operate. Patients should have X-ray examinations in two directions (AP view and lateral view). Foreign bodies which have high density such as metals, stones, and glasses are clearly seen by X-ray.[3] With the help of CT or magnetic resonance imaging (MRI) accurate foreign body localization is possible. MRI is useful for the detection of nonmetallic foreign bodies only.[4] CT scan, which has high resolution and positive rate in comparison to X-ray is considered the gold standard for the diagnosis of the intraocular foreign body[5] mainly for diagnosing small metallic foreign bodies and nonmetallic foreign bodies. With the help of CT structure of eyeball and clear anatomical position of foreign body can be seen. In addition, ophthalmologists can estimate nature of foreign bodies according to their CT values and artifacts. Both axial scan and coronal scan should be taken for precisely locating the intraocular foreign body.[3] However, CT scan is not useful in the detection of nonmetallic foreign body such as wood as dry wood is hypodense, and resembles gas in CT scan which is often found in orbital tissues after injuries[1] with coexistent sinus damage.[6] Ultrasonography is useful for the detection and diagnosis of associated ocular injuries such as traumatic cataract, vitreous hemorrhage, and vitreous detachment.[1] Angiography is essential when vessel damage is suspected.[6] Development of complication depends on entry wound and canal, sharpness of foreign body edge, retainment period, and impact force. Chronic orbital inflammation, osteomyelitis, thrombotic vasculitis, and diffuse infections in form of septicemia will develop as complications.[7] Optic, oculomotor, and abducent nerves, eyeball, and retinal artery can be damaged. Therefore, foreign body removal is strongly recommended.[6]


  Conclusion Top


Ultrasound and CT scans are ex

cellent modalities for the detection of intraocular metallic foreign bodies helping ophthalmologists in prompt management of patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Adesanya OO, Dawkins DM. Intraorbital wooden foreign body (IOFB): Mimicking air on CT. Emerg Radiol 2007;14:45-9.  Back to cited text no. 1
    
2.
Ehlers JP, Kunimoto DY, Ittoop S, Maguire JI, Ho AC, Regillo CD. Metallic intraocular foreign bodies: Characteristics, interventions, and prognostic factors for visual outcome and globe survival. Am J Ophthalmol 2008;146:427-33.  Back to cited text no. 2
    
3.
Yan H, Wang J, You C, Meng X. Intraocular foreign bodies. Mechanical Ocular Trauma. Singapore: Springer; 2017. p. 49-67.  Back to cited text no. 3
    
4.
Yamashita K, Noguchi T, Mihara F, Yoshiura T, Togao O, Yoshikawa H, et al. An intraorbital wooden foreign body: Description of a case and a variety of CT appearances. Emerg Radiol 2007;14:41-3.  Back to cited text no. 4
    
5.
Rubinstein A, Riddell CE, Kafil-Hussain N, Assaf A. Self-inserted intraorbital foreign bodies. Ophthalmic Plast Reconstr Surg 2005;21:156-7.  Back to cited text no. 5
    
6.
Pokhraj PS, Jigar JP, Mehta C, Narottam AP. Intraocular metallic foreign body: Role of computed tomography. J Clin Diagn Res 2014;8:D01-3.  Back to cited text no. 6
    
7.
Bai HQ, Yao L, Meng XX, Wang YX, Wang DB. Visual outcome following intraocular foreign bodies: A retrospective review of 5-year clinical experience. Eur J Ophthalmol 2011;21:98-103.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2]



 

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