A gentleman working in Sainsburys dropped a jam jar which shattered and he felt a fragment hit his right eye. Prior to being seen he had had eye irrigation.
On examination he had an irritated red eye with some lacrimation. Visual acuity and eye movements were all intact with no severe pain. Using a slit lamp and Fluorescein staining there were no visible abrasions or clear retained foreign body (FB). Despite this he still complained of a FB feeling in his eye.
Ocular ultrasound was done showing the below image:
Question: Can you spot the abnormality?
A hyperechoic structure is visible representing the foreign body (green circle).
In cases of intraocular FBs, linear areas of mobile hyperechoic material, adjacent to the FB, may represent possible vitreous haemorrhage.
Under LA eye drops, targeted cleaning and irrigation, repeat ultrasound showed that the FB was removed (below image).
The patient felt better and was discharged with Chloramphenicol eye-drops and safety netted appropriately.
Ocular Foreign Bodies:
Patients presenting with ocular foreign body can be easily missed, as they may not complain of vision loss or severe pain. Only a small entry wound may be found on careful examination. However, these seemingly harmless injuries may be vision threatening, particularly in case of intraorbital FBs. IOFBs must be removed surgically in the majority of cases (>90%).
Bedside ultrasound is a useful tool in looking for most FBs, particularly metallic objects. Orbital non-contrast CT continues to be the exam of choice in visualising metal and graphite; however, ultrasound is the best imaging modality in detection of retained wooden FBs. Wooden FBs can be detected if >0.5mm in size. Good knowledge of surrounding anatomy and other hyperechoic structures in the area is essential to avoid misidentifying structures.
Many thanks to Dr Ahmed Abdul-Ghani for this great case and images.
- Feldman M, et al. Intraocular Foreign Body: Ultrasound and CT Findings. JETem 2017. 2(1):V29-30
- Javadrashid R, Fouladi DF, Golamian M, Hajalioghli P, Daghighi MH, Shahmorady Z, et al. Visibility of different foreign bodies in the maxillofacial region using plain radiography, CT, MRI and ultrasonography: an in vitro study. Dentomaxillofac Radiol. 2015;44(4):20140229. doi: 10.1259/dmfr.20140229