The Incidence of Intraocular Foreign Bodies and Other Intraocular Findings in Patients with Corneal Metal Foreign Bodies

Purpose: To review the findings of dilated fundus examinations (DFEs) in patients with the diagnosis of corneal metal foreign body (CMFB) and to assess the likelihood of concomitant intraocular foreign body (IOFB) in this clinical setting. Design: Retrospective, case review series. Participants: All 288 cases with a new diagnosis of CMFB that had a documented DFE in the emergency department at Massachusetts Eye and Ear Infirmary from January 1, 2008, to December 31, 2008. In addition, all 9 separate cases of metal IOFB seen in the same time period were also reviewed. Methods: The medical records of all patients were individually reviewed. Main Outcome Measures: The DFE findings of each visit were analyzed in addition to mechanism of injury, visual acuity and anterior segment abnormalities. Results: Of the 288 CMFB cases, all but 1 presented without corneal or conjunctival laceration. The etiologies of the injuries included low-and high-velocity impact. Best-corrected visual acuity ranged between 20/15 and 20/150. The anterior chamber (AC) reaction ranged from quiet to 4+ cells. None of the DFEs revealed an IOFB. Only 1 case had a posterior segment abnormality related to the injury-commotion retinae in the setting of an explosion. There were 14 cases with unrelated DFE findings. Among the separate 9 cases of metal IOFB reviewed, all had a history of high-velocity injury and evidence of corneal or conjunctival laceration. In 1 of the 9 cases, the IOFB was protruding from the cornea; in 2 cases, IOFBs were seen on DFE. Six cases were diagnosed by computed tomography. All documented AC examinations for this group of patients had significant findings such as 4+ cells, hyphema, or lens fragments. Conclusions: The finding of IOFB on a DFE for patients with a CMFB without clinical evidence of penetrating injury is very rare.