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Alizarin blue, rhodanine, and rubeanic acid stains cytochemically localized copper in rabbit eyes harboring intravitreal copper foreign bodies of varying copper composition. Local deposition presented in small amounts in areas adjacent to the foreign body (fibrous capsule, adjacent retina, and surrounding macrophages). The localized pattern was more frequent with the 60% copper alloy, when the foreign body was encapsulated or shiny, and when the aqueous copper concentration was normal. The generalized pattern of copper deposition revealed moderate to marked amounts of copper within the following multiple intraocular structures: (1) the posterior cortex of the lens, (2) the vitreous cavity, either in free-floating macrophages or in macrophages on the surface of the retina, (3) the retina, either within monocytic macrophages, Müller cells, or extracellularly in granular clumps, and (4) the fibrous capsule around the foreign body. Copper in several eyes was observed within macrophages that were clustered around the central retinal vessels within the optic nerve. The generalized pattern was frequent with the pure copper foreign body, when the copper foreign body was tarnished, and when copper concentration of the aqueous humor was elevated. There was a direct toxic effect of copper on the lens in the form of local opacification in the posterior cortex but no clinical or histochemical evidence of a Kayser-Fleisher ring or a sunflower cataract.

Diagnostic ultrasound is a noninvasive, well tolerated, safe procedure with no toxicity which aids the ophthalmologist by demonstrating the integrity of the intraocular contents or the presence of tumors, retinal detachments, vitreous membranes or hemorrhage, foreign bodies or other structural changes in eyes with opaque media which cannot be adequately evaluated optically. Orbital mass lesions and inflammatory changes can be demonstrated and ultrasonic evaluation should be utilized early in the diagnostic evaluation of exophthalmus in combination with other radiographic techniques. The ultrasound examination does require a certain technical skill and experience in interpretation as well as judgment in order for it to be a reliable diagnostic test.

Two unusual events concerning intraocular foreign bodies are presented. The first patient had an occult or unsuspected intraocular foreign body. He showed iridoplegia with mydriasis, siderosis iridis, and an intraocular piece of iron lying posteriorly near the retina. The foreign body was removed and the patient regained normal iris color and pupillary activity. His vision remains 20/15 six years postoperatively dispite ensuing retinal detachment one year after removal of the foreign body. The second patient was a young boy injured by a blasting cap explosion. He lost one eye from the injury and had a piece of intraocular brass in his left eye. In spite of the development of chalcosis and a mature cataract the lens gradually shrank in the pupillary space permitting a clear aphakic area and 20/25 vision. The brass fragment migrated forward and inferiorly and was finally extruded under the conjunctiva five years later, where it was removed and chemically analyzed by x-ray diffraction.

The X-ray localization of intraocular foreign bodies is based on an average-sized schematic eye. Whether or not a foreign body only reached or penetrated the rear wall of the bulbus often cannot be decided safely - even if X-ray checks included other than straight forward gaze directions. By means of ultrasound it is possible. 1. to measure exactly the real dimensions of the patients eye and to alter the X-ray localization scheme (W. Comberg's scheme) correspondingly. This improves the accuracy of the X-ray localization technique. 2. To localize the foreign body directly and exactly by presentation of its echo. Simultaneous presentation of the bulbus rear wall echo permits determination of the foreign body position. - A case record is given.

The management of 34 intracocular foreign bodies is reviewed. When possible the removal of the foreign body was carried out in the quadrant closet to where the foreign body was located and through a site 4-5 mm from the limbus. A circumferential incision was made after tenting had been demonstrated while the magnet was applied to the sclera. Sweet localization and B-scan ultrasound were helfpul in patients with opague media. In particular, ultrasound was used to confirm the magenetic qualities of the foreign body when it could not be visualized ophthalmoscopically. Visual results were surprisingly gratifying, even when the foreign body had damaged the cornea and lens as evidenced by the fact that 26 patients (77%) utimately achieved a vision of 20/50 or better.

In summary, the following program should be useful for the physician who encounters a child with a suspected eye injury: 1. Obtain a history. What was the child doing when he hurt his eye? 2. Examine the child by first inspecting the lids. Evert the lids with a cotton tipped applicator if necessary and if the globe is intact. Look at the canalicular area and decide whether the lacrimal drainage system is disrupted. Is a lid laceration deep enough to affect the levator? Could the orbital rim or any bony structures be involved? Should an x-ray film for fracture or foreign body be obtained? Is the anterior segment of the globe intact? What is the condition of the conjunctiva and cornea? Should fluorescein stain be applied to the cornea in an attempt to determine the presence of corneal abrasion? Put proparacaine hydrochloride 0.5 per cent drops in the eye if it is too sensitive or photophobic to allow opening of the lids. Is there blood in the anterior chamber? Does the lens look opaque? Is the cornea lacerated, is the globe ruptured? Does the patient have double vision? Is the eye obviously displaced relative to the other eye? 3. Check visual acuity-! Visual acuity may be checked initially or after examination of the eye, but some recording of the visual acuity should always be made. An elegent chart is not necessary. The child may be asked to identify letters on a prescription pad or merely record the presence of light, count fingers, etc., whichever is nearest maximal visual potential. 4. A decision should be made with regard to further diagnostic techniques including the decision, should an ophthalmologist be consulted? 5. Treat minimal anterior segment or adnexal injuries with or without consultation with an ophthalmologist. 6. If the injury is extensive, resist the urge to do something immediately; merely patch the eye and put the child in the hands of an ophthalmologist.

BB shots and other spherical foreign bodies produce long chains of rapidly successive echo spikes which gradually decrease in height. These patterns are specific for this type of foreign bodies and allow their reliable detection and accurate localization. A-scan echography has become a very useful addition to X-ray examination in order to determine whether such foreign bodies are intra- or extraocular. Echography also helps to localize such foreign bodies during surgery and to evaluate the posterior segment of the eye in the presence of opaque ocular media (hemorrhages, cataract). Although it is sometimes possible to demonstrate specific B-scan patterns of spherical foreign bodies, A-scan echography is the method of choice since it is faster, more reliable and more accurate.

The use of B-can ultrasonography in ophthalmology is becoming increasingly important. There are several advantages of the Bronson-Turner system when compared with other B-scan instruments. The unit is quite compact and much less expensive. There is no need for a special laboratory and trained personnel, since it is operated easily by the ophthalmologist. Because a water bath is not necessary, uncooperative patients and children can be evluated. This instrument has been proven reliable and accurate in the diagnosis of retinal detachment, choroidal tumors, and intraocular foreign bodies, and is also capable of revealing more subtle abnormalities such as retinoschisis and vitreous membranes. The Bronson-Turner ultrasonoscope provides the clinician with a valuable instrument to evaluate ocular abnormalities in the presence of opaque media.

92 eyes have been examined with A-scan ultrasonography (8 MHz, Kretz-Technik apparatus 7100 MA and 7200 MA). Ultrasonic location of nonmagnetic and magnetic foreign bodies is compared to Comberg's radiographs and to intraoperative methods usch as stereoradioscopy or transillumination with the glass fiber diaphanoscope. Definitely corresponding results have been obtained in 60 cases. Ultrasonic location was difficult with small foreign bodies (reflecting surface less than 2 mm-2) within the orbit, the sclera, or within less than 2 mm from the sclera, as well as in severe vitreous clouding. Such cases should be evaluated with all location procedures available before considering further management.

The development and early clinical results of a real-time color B-scan ultrasonoscope are described. This instrument uses color to display detailed echo amplitude information more quantitatively than is possible with gray scale. With real time, dynamic changes are seen during the examination. Conversion of the amplitude information into binary coded decimal code permits separation into ten color steps and also eliminates "blooming" of the cathode ray tube, as seen in black and white. Integrated circuitry is used, providing a portable, relatively inexpensive unit. Early clinical work in ophthalmology is illustrated.

Ultrasound examination has emerged as a valuable technique for defining soft tissue abnormalities of the eye and orbit. As high frequency sound waves (5 to 20 megahertz) are projected through soft tissues, echoes are produced at tissue interfaces. These echoes are displayed on oscilloscopes as either one-dimensional amplitude spikes (A-mode ultrasonography), or as dots integrated into a two-dimensional image representing a thin section through the entire orbit (B-scan ultrasonography). A-mode indicates tissue substance, while B-scan illustrates tissue morphology. With this technique, orbital tumors are clearly distinguished in terms of their location, size, and configuration, as well as the basic tissue type (cystic, solid, angiomatous or infiltrative). Other orbital processes are defined by ultrasonography also, including inflammatory conditions such as diffuse pseudotumor or cellulitis, congestive conditions such as dysthyroid exophthalmos, and orbital hemorrhage. Intracranial and vascular etiologies of exophthalmos have no specific ultrasound signs. In a series of 258 consecutive patients with unilateral exophthalmos examined with ultrasonography, diagnosis of tumor was made in 26 percent (66 cases). Overall accuracy of orbital tumor diagnosis by ultrasonography was 94 percent in this series. Tumor localization, configuration, and extent indicated by the test aided in selecting surgical approaches. Other patients in the series were diagnosed ultrasonically as a variety of other entities, mostly inflammatory and dysthyroid exophthalmos. Normal ultrasound studies were found in 19 percent. None of these patients had subsequent diagnosis of tumor. Diagnostic ultrasonography is capable of detecting orbital tumors and distinguishing them from inflammatory, congestive, and other causes of exophthalmos with a high degree of reliability. The test is painless, well tolerated, non-invasive, and non-toxic. It now has a prominent role in evaluation of any patient with exophthalmos.

Insults from corneal foreigh bodies range from trivial windblown debris through destructive chemicals, penetrating wounds, and severe secondary infection. History and preliminary examination should begin concurrently, particularly in the case of chemically active compounds. Needed auxiliaries are topical anesthetics, oblique light, magnification, sterile sodium fluorescein for diagnostic staining of surface breaks, removal instruments, and topical antibiotics to reduce the potential of secondary infection. A steadied, seated position for the physician, resting posture with hands supported on the face, and an oblique approach tend to reduce the likelihood of unwanted perforations or scars. An irrigating stream of sterile saline delivered through a 25 gauge short needle on a 5 cc syringe will dislodge most recent foreign bodies. The sterile needle is also available as a spud. Corneal thickness varies from slightly above 1 mm in the periphery to less than 0.5 mm centrally. Therefore, it is essential to have clear visualization of the foreign body in relation to corneal depth. Dislodgment into the anterior chamber or incidental perforation of the cornea generally require hospitalization, intensive antibiotics, and steroid therapy.

Ocular ultrasonic transmission holography of the eye using equipment capable of real-time imaging has not previously been described. A method using pulsed ultrasound focused on an air/liquid interface is used to demonstate normal ocular structures including lens, optic nerve, and sclera. Intraocular foreign bodies imaged include radiopaque and nonradiopaque materials. A limit of resolution of at lease 1 mm. is demonstrated.

A report is given of a case with a mycotic process of the lacrimal sac, the course of which covers a period of 20 years until final cure. Symptoms, diagnosis and therapy are discussed.