A Rare Presentation of Two Cases of Metallic Intrascleral Foreign Body Entry through Upper Eyelid

Abstract

Ocular injury secondary to foreign body remains an important cause of ocular morbidity with or without blindness in working population. Intraocular foreign body may have varied clinical presentation. Initially it may look an apparently normal eye followed by obvious ocular symptoms depending upon its location and degree of inflammation. It can result in partial or full thickness penetration of sclera with or without involvement of posterior segment. We hereby present two cases of metallic intrascleral foreign body entry through upper lid in young carpenters following hammer and chisel injury. In case 1, Intrascleral location of foreign body was confirmed with X ray orbit and B scan ultrasonography while in case 2 the diagnosis of intrascleral foreign body was missed at the first visit to ophthalmology clinic Both the patients underwent exploratory surgeries where intrascleral metallic foreign bodies were found without ocular penetration. An intrascleral foreign body may be missed due to small penetrating scleral wound covered by a large subconjunctival haemorrhage accompanied by minimal or no signs of inflammation and failure on part of treating ophthalmologist to suspect an intrascleral foreign body. To establish a diagnosis of intraocular particularly intrascleral foreign body, careful history taking and clinical examination along with use of imaging studies are mandatory steps which help in successful management and good visual outcome. These cases highlight the importance of considering a presumptive diagnosis of retained intrascleral foreign body in every patient with a history of penetrating ocular trauma through lid or a visible wound/scar on the lid.

Embedded Episcleral Foreign Body Mimicking Nodular Anterior Scleritis

“…Detection of intrascleral/episcleral FBs may not be easy on slit-lamp examination due to the presence of a small penetrating wound covered by a large subconjunctival hemorrhage accompanied by minimal or no signs of inflammation. 1 However, underlying inflammation may ensue and the patients may present with a clinical picture resembling scleritis, as in our case.…”

“…Intraocular FBs may present with various clinical manifestations and affect both the anterior and posterior segments of the eye. 1 , 8 Young male workers are the most frequently affected patient group due to work accidents. 8 …”

“…Ocular injury involving a foreign body (FB) may impose significant ocular morbidity and visual disability depending on the extent of the injury as well as the nature and location of the FB. 1 A superficial FB in the conjunctiva or cornea can be easily detected and removed, and thus may not cause much harm if treated appropriately without delay. 2 Subconjunctival FBs are relatively rare, commonly missed, and may present as FB granuloma.…”