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Trauma and Surgery Intraocular Foreign Bodies—A Review from Entry to Exit and Beyond Jiaxi Ding, MD, 1 Sandra Fernando-Sieminski, MD 2 and Pradeepa Yoganathan, MD 3 1. Glaucoma Fellow, Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, Iowa, US; 2. Ophthalmologist and Glaucoma Specialist; 3. Ophthalmologist and Vitreoretinal Specialist, Department of Ophthalmology, Ross Eye Institute, The State University of New York, University at Buffalo, Buffalo, New York, US Abstract Ophthalmic trauma, the leading cause of irreversible blindness in young adults, may be associated with obvious or occult intraocular foreign bodies (IOFBs). Critical work-up includes careful history-taking as well as slit-lamp and dilated eye examination. These components are frequently supplemented by imaging tests. Currently, computed tomography is the mainstream modality, offering highly sensitive detection and localization of IOFBs as small as 0.5 mm. IOFBs impact visual prognosis by producing direct damage, causing secondary toxicity, and increasing infectious risk. Factors bearing a poor visual prognosis include large IOFB size, posterior segment location of IOFB, and retinal detachment or endophthalmitis on presentation. Timing of IOFB removal is controversial, but when possible, it is preferable to perform extraction within 24 to 48 hours of initial injury. Antibiotic coverage is also recommended with options of oral alone, intravenous followed by oral, or combination of intravitreal and oral. Even as technology and surgical techniques continue to improve IOFB management, we must still advocate accident prevention to our patients through education and emphasis of protective eyewear. Keywords Eye trauma, intraocular foreign body, traumatic endophthalmitis, chalcosis, siderosis Disclosure: Jiaxi Ding, MD, Sandra Fernando-Sieminski, MD, and Pradeepa Yoganathan, MD, have no sources of support or financial disclosures to report. No funding was received in the publication of this article. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, adaptation, and reproduction provided the original author(s) and source are given appropriate credit. Received: May 1, 2015 Accepted: July 13, 2015 Citation: US Ophthalmic Review, 2015;8(2):135–8 Correspondence: Jiaxi Ding, MD, Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, US. E: In the US, approximately 3 % of all emergency department visits are related to eye trauma. 1 Many of these cases unfortunately lead to permanent visual impairment as ocular injury accounts for the leading cause of irreversible vision loss in teenagers and young adults. 2,3 When penetrating or open- globe injuries occur, an estimated 10 to 41 % involve an intraocular foreign body (IOFB). 4–6 The IOFB may be overtly recognizable, but it may also be obscured by hemorrhage (as hyphema and/or in the vitreous), traumatic cataract, marked inflammation, or retinal detachment. At times, it could be inconspicuously lodged in the angle, in the sulcus, or in the far retinal periphery. Up to 20 % of patients with IOFB present with no pain or decreased vision. 3,7 Therefore, a full and detailed ophthalmic examination including slit-lamp biomicroscopy and dilated examination is critical. Important information to be gained from tonometry, gonioscopy, ultrasonography, and scleral depression may not be feasible in the setting of globe penetration or perforation and if other concurrent systemic injuries warrant immediate medical attention. Overall, in the acute setting of eye trauma, the examiner must maintain a high index of suspicion for possible retained IOFBs. Mechanism of Injury The mechanism of injury can be a most important cue. Among the civilian population, the most common source of IOFB is work-related accidents Tou ch MEd ica l MEdia with hammering being the largest culprit, followed by chiseling. 8–10 In the military sector, trauma is frequently related to combat involving explosives with projectiles. These injuries resulting from blast fragments have been theorized to carry a lower infectious risk as the high speed and temperature may induce a sterilizing effect. 4,11,12 Epidemiology There is a clear preponderance in the demographics of patients presenting with IOFBs. More than 90 % are young males with average age between 25 and 39 years. 3,4,10 Most patients are relatively healthy with minimal co-morbidities and good visual acuity prior to the acute injury. Categorizations of Intraocular Foreign Bodies By Composition Broadly, IOFBs can be divided into metallic or nonmetallic subcategories, which can have implications upon modality of diagnosis, infectious risk, and long-term visual prognosis. Wichkham et al. reported that a vast majority (over 80  %) of IOFBs are metallic in nature. 3,4,6,9 While metallic foreign bodies are associated with less risk for endophthalmitis compared with organic material, 11 they may cause complications related to intraocular toxicity that can lead to acute and chronic visual loss, particularly with 135