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INTRAOCULAR METALLIC FOREIGN BODY followed by a penetrating trauma: CASE REPORT
We describe a case of intraocular metallic foreign body after penetrating trauma.
Relato do Caso
A 25 year-old male was referred to us with red eye, photophobia and low visual acuity in his right eye, triggered by penetrating trauma with metallic material when he was hammering a steel object without wearing safety glasses. On examination, his best corrected visual acuity was 20/50 in the OD and 20/30 in the OS. On the slit-lamp examination was observed anterior chamber reaction (1 + / 4 +) a self-sealed corneal lesion of 2mm in the nasal portion, and an iris lesion on the same position in the OD. The OS was unremarkable. Fundoscopy in the OD showed vitreous and pre-retinal hemorrhage in the right inferior temporal quadrant associated with whitish choroidal lesion. Fundus in the left eye was normal. The orbits X-ray showed a linear metallic artifact in right orbit. The orbits CT-scan revealed high attenuation oval image projected on the midline of the lower quadrants of the right orbit, located inside the eyeball. Pars plana vitrectomy in the OD was indicated.
Intraocular metallic foreign body (IMFB) is a sight-threatening condition. Ocular siderosis is a common complication of retained IMFB and it is characterized by a pigmentary and degenerative change in the eye, leading to a retinal degeneration. IMFB usually occur in the setting of machining, construction or auto repair. The commonest cause of injury is hammering steel. History is usually of striking metal with poor or no eye protection at all. Patient typically shows ocular irritation, redness with or no alteration of the visual acuity. Diagnosis is commonly made by slit-lamp examination, which can detect foreign body in the lens, anterior chamber or by a dilated fundus examination. A plain orbital X-ray is recommended imaging for detection of an IMFB, but if negative a computed tomography scan is then indicated. Pars plana vitrectomy is the mainstay treatment of IMFB to remove the foreign body to avoid permanent loss vision. Suspicion of IMFB must be investigated in all patients with suspicion of penetrating ocular trauma.
ERIKA ANDRADE SANTOS, PEDRO GOMES MOREIRA, RICARDO EVANGELISTA MARROCOS ARAGÃO