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Penetrating Eye Injuries and Intraocular Foreign Bodies
Penetrating eye injuries are one of the most important causes of acute and permanent vision loss in children and young people. Especially intraocular foreign bodies (IFOs) are emergencies that are common among traumatic eye injuries and cause serious problems.
In various series, it has been reported that 18 to 40% of penetrating eye injuries are accompanied by intraocular foreign bodies. In addition to frequently causing damage to different degrees in different tissues, they can create complications such as risk of infection, retinal detachment and metallosis.
In eye injuries associated with an intraocular foreign body (IFB), there is a risk of vision loss depending on many factors such as the mechanism of the injury, the location and size of the IFB, and postoperative endophthalmitis.
Although developing vitreoretinal surgical techniques prevent many sequelae of intraocular foreign body injuries, blindness or profound vision loss is a common result of such injuries.
Even in case of successful completion of intraocular foreign bodies treatment, epiretinal membrane, fibrovascular proliferation, Complications such as retinal detachment and proliferative vitreoretinopathy are common and sight-threatening.
Preoperative Evaluation
To plan effective surgery, careful preliminary evaluation is essential. A good anamnesis, a detailed eye examination, appropriate imaging to detect the presence, localization and size of IOF and prophylactic antimicrobial treatment are important stages of the preoperative preparation period.
Izmir Intraocular Foreign Body Examination
The mechanism of the injury and what caused it (cutting tools, explosives, glass, etc.) should be questioned. However, before focusing on the eye, life-threatening factors other than the eye must be identified and necessary precautions must be taken.
A complete ophthalmic examination should be performed. However, if there is a rupture or suspicion of rupture in the eyeball, maneuvers that apply even a small amount of pressure to the eye, such as measuring eye pressure, should be avoided.
During ophthalmic examination, factors that may determine future visual prognosis, such as initial visual acuity, presence or absence of endophthalmitis (intraocular infection), globe rupture, perforating injury, retinal detachment, afferent pupillary defect, should be evaluated and noted.
If IBD is detected clinically, factors that will negatively affect the visual prognosis have been identified as low initial visual acuity, afferent pupillary defect, hyphema, vitreous hemorrhage, retinal detachment, and uveal prolapse.
After the preparations are completed, some important strategies regarding the surgery should be determined. These are the time of surgical intervention (early or late), the vitrectomy technique, the condition of the crystalline lens (lens preservation or lens extraction), the way and tools to remove GIC, and the use of intraoperative antibiotics.
What to do if a foreign object enters the eye?
One of the important issues of emergency intervention is what to do in case a foreign object enters the eye. A foreign object entering the eye is a serious eye trauma and requires urgent intervention. Especially in cases of penetrating injuries, sharp objects or metal fragments entering the eye, immediate action should be taken without wasting time to see a doctor. If a foreign object gets into the eye, the first thing to do is not to rub the eye or wash it with water. This may cause the foreign object to become buried deeper and cause more damage. The eyelids should not be closed or a foreign object should not be removed. Removal of the foreign body should be done by an ophthalmologist.
The ophthalmologist can determine the location and size of the foreign body using a special microscope. The foreign body can be removed with the help of a special tool or may need to be removed with laser or surgical methods. In case of penetrating injuries or serious eye damage, surgical intervention may be required. In case of a foreign body entering the eye, treatment should be started quickly. If not treated early, the foreign body can cause further damage inside the eye and even lead to permanent vision loss. Therefore, it is important to consult an ophthalmologist without delay in case of a foreign object entering the eye.
How to Treat Eye Injury?
Treatment of eye injuries may vary depending on the level and type of injury. For example, if ingredients get into the eye, medication may be injected into the eye and a tube may be inserted into the eye. Additionally, foreign objects inside the eye may need to be removed. In case of a more serious eye injury, surgical intervention may be required. Eye injuries are conditions that cause damage to the tissues in the eyes and can affect the quality of vision. Treatment of eye injuries may vary depending on the level and type of injury. The important thing is to diagnose and intervene in eye injuries early. How the treatment is applied may vary depending on the situation.
Timing in Removal of Intraocular Foreign Body
The decision to remove GIC during primary globe repair depends on many factors. First of all, the patient’s general health condition must allow this surgery. Apart from this, the appropriate surgical environment, the surgeon, the supporting staff and the surgical instruments required to remove the foreign body must be ready at that time.
Additionally, removal of an intraocular foreign body requires an extremely good imaging environment. However, in these types of injuries, especially corneal cloudiness often makes it impossible to visualize the posterior segment of the eye. Only when all these conditions are ready, the issuance of GİYC should be considered.
It is known that removal of the GIC during globe repair reduces the risk of endophthalmitis and proliferative vitreoretinopathy (PVR), which results from a retinal tear and is characterized by the development of tractional tissue above and below the retina.
It has been reported that the risk of endophthalmitis decreases from 13% to 3% with early vitrectomy performed in the first 24 hours. However, the effect of early or late vitrectomy on the final anatomical and visual success is controversial. In addition to the studies mentioning the positive effect of early vitrectomy on the final visual acuity, there are also studies reporting that no difference is observed.
Intraocular foreign bodies are traumas that cause serious vision loss and are quite common among open eye injuries. Treatment of GIBS requires an algorithm that includes many issues such as the mechanism of injury, the nature of the foreign body, its location, size, conditions of the surgical environment and personnel, and serious follow-up in terms of the development of potential postoperative complications.
Following the detection and treatment of life-threatening extraocular injuries, anamnesis, ophthalmic examination and imaging methods should be applied to determine the location and characteristics of the foreign body. It is important to explain the seriousness of the situation to the patient as much as possible in order to make the patient’s expectations realistic.
Although early or late removal of GIC is a controversial issue, the condition of the eye, the surgical environment and the condition of the surgical staff must be evaluated and optimal conditions are required in making this decision.
Appropriate antibiotic prophylaxis before and after surgery is important in minimizing the risk of endophthalmitis. It is beneficial to see the patient frequently to prevent vision-threatening complications such as retinal detachment, PVR, and endophthalmitis after surgery.
References:
Williams, D. F., Mieler, W. F., Abrams, G. W., & Lewis, H. (1988). Results and prognostic factors in penetrating ocular injuries with retained intraocular foreign bodies. Ophthalmology, 95(7), 911-916.