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Introduction: Corneal foreign bodies account for nearly one-third of all eye injuries and are a common emergency in ophthalmology. While many cases are straightforward, involving clear diagnosis and treatment, some present significant challenges due to the complexity of the foreign body involved., Observation: A 20-year-old male presented with discomfort in his right eye following an accident while cutting a tree without wearing protective eyewear. Examination using slit-lamp biomicroscopy revealed a reed foreign body embedded in the cornea. Anterior Segment Optical Coherence Tomography (AS-OCT) provided detailed images, showing the foreign body embedded 300 µm beneath the corneal epithelium but not affecting deeper layers. The foreign body was surgically removed under topical anesthesia, followed by thorough cleansing and suturing of the wound., Conclusion: AS-OCT is invaluable in the diagnosis and management of complex corneal foreign bodies, enabling precise treatment planning and successful outcomes, as demonstrated in this case.

During outdoor work in April 2022, a 48-year-old man was stabbed by a tree branch and underwent intraocular foreign body extraction and repair of the scleral wound with sutures and amniotic membrane graft at a local hospital. Steroid therapy with prednisone was prescribed after a diagnosis of uveitis. Vitrectomy was performed in June 2023; a fungal culture was positive, and ITS sequencing identified the organism as Paradictyoarthrinium diffractum. Empiric antifungal therapy did not have an effect, and, because of deterioration of the condition, the left eye was enucleated in October 2023. P. diffractum is a mangrove host-specific saprophytic fungus that has not been reported in humans., Competing Interests: Declarations of competing interest The authors have no competing interests to declare., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

A 54-year-old female noticed a 2-month history of an enlarging left inferomedial orbital rim mass. The patient remembered a pencil injury at approximately 7 years of age. Her complete ophthalmic examination was otherwise unremarkable. She underwent CT orbital imaging, demonstrating a centrally hyperdense lesion along the left inferomedial orbital rim. There was no involvement of the nasolacrimal duct system. The patient underwent an excisional biopsy. The pathology disclosed noncaseating granulomatous inflammation to particulate black material consistent with graphite., Competing Interests: D.M.S. is a consultant and speaker for Amgen. The remaining authors have no conflicts of interest to disclose., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.)

Background: Removal of orbital foreign bodies is a surgical challenge. The purpose of this study is to report our experience in the removal of orbital foreign bodies and to evaluate the usefulness of various technological aids in their removal., Materials and Methods: We conducted a single-center retrospective study at Nice University Hospital (France) from January 2017 to December 2023. All patients undergoing surgery for an orbital foreign body during the study period were included. Data recorded included the nature of the orbital foreign body, its size, location, surgical route, outcome (success, partial success, failure), and technological aids used (intraoperative navigation, intraoperative imaging scope, orbital magnet). Concurrently, we designed a dedicated orbital magnet, which was tested in the anatomy laboratory and in two of our patients., Results: Six patients, all young men, were included during the study period. Removal was successful, partially successful, or unsuccessful in one-third of cases, respectively. Failure was associated with orbital foreign bodies located in the intraconal or posterior orbital space. Preoperatively, the use of a "low-artifact" scanner allowed us to better determine the exact size and shape of the orbital foreign body. Intraoperative navigation was not accurate enough, due to the mobility of the orbital bodies within the orbital fat. In our experience, intraoperative scope imaging was more accurate. The use of a dedicated orbital magnet was successfully tested in the anatomy laboratory and allowed the removal of a small orbital foreign body in one of our patients. Intraoperative surgical videos are provided., Conclusion: Vegetal orbital foreign bodies must be systematically removed. Removal of non-vegetal orbital foreign bodies should be considered on a case-by-case basis based on their size, best assessed using a "low artifact" scanner, their location, and their intrinsic ferromagnetism. Intraoperative navigation does not appear useful, while intraoperative scope imaging does. A dedicated orbital magnet might be helpful in removing ferromagnetic orbital foreign bodies. However, an orbital magnet may be ineffective in removing intraorbital bullets, since they are made primarily of an alloy of copper and lead., (Copyright © 2024 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Background: Ocular siderosis (OS) is a significant cause of visual loss due to retained ferrous intraocular foreign bodies (IOFB). Despite its rarity, OS can lead to severe visual impairment if not promptly diagnosed and treated. This case is notable due to the occult nature of the IOFB, which was undetected by standard imaging modalities, emphasizing the critical role of magnetic resonance imaging (MRI) in such scenarios., Case Presentation: A 51-year-old Caucasian male presented with progressive vision loss in his right eye over 20 days. Best corrected visual acuity (BCVA) was 20/1000 in the right eye and 20/20 in the left eye. Intraocular pressure (IOP) was 9 mmHg in both eyes. Slit-lamp examination revealed a small linear corneal wound and an iris defect in the right eye, along with a cataract featuring brownish deposits on the anterior capsule. The left eye was normal. Fundus examination of the right eye was hindered by media opacities. Ultrasonography showed a flat retina and choroid with no detectable IOFB. Despite a strong clinical suspicion of OS, computed tomography (CT) did not detect any IOFB. MRI subsequently identified an artifact in the inferior sectors of the right eye, indicative of a metallic IOFB. Surgical intervention involved a 23-gauge vitrectomy, phacoemulsification, IOFB removal and silicon oil (SO) tamponade resulting in a fully restored VA of 20/20 and normal IOP one month post-operation. SO was removed 2 months later. The retina remained adherent with no PVR development, and optical coherence tomography (OCT) scans showed a normal macula., Conclusions: This case underscores the importance of considering OS in patients with unexplained vision loss and history of ocular trauma, even when initial imaging fails to detect an IOFB. MRI proved crucial in identifying the IOFB, highlighting its value in the diagnostic process. Early detection and surgical removal of IOFBs are essential to prevent irreversible visual damage. This case demonstrates that MRI should be employed when CT and ultrasonography are inconclusive, ensuring accurate diagnosis and timely intervention to preserve vision., (© 2024. The Author(s).)

Background and Objective: This study aimed to identify the prognostic factors regarding the visual and anatomic outcomes of eyes with posterior segment intraocular foreign body (PS-IOFB)., Patients and Methods: The medical records of 95 patients who underwent pars plana vitrectomy and PS-IOFB removal between 2004 and 2021 were retrospectively reviewed. Data on anatomical and visual outcomes, as well as preoperative, intraoperative, and postoperative variables were statistically analyzed., Results: The mean age of the patients was 31.9 ± 12.3 years. The mean follow-up time was 21.9 ± 28.3 months. The median time interval from trauma to IOFB removal was 9 days. In univariate analysis, there was a positive correlation between initial visual acuity (VA) and final VA ( P < 0.001). A higher ocular trauma score (OTS) was significantly associated with both anatomical and functional success ( P < 0.001). Linear regression analysis showed that OTS was not superior to initial VA in predicting final VA ( r = 0.625 vs r = -0.601). Anatomic and functional outcomes were not affected by the injury site, nature of PS-IOFB, or timing of PS-IOFB removal ( P > 0.05 for all). Subretinal IOFB location, the need for silicone oil tamponade, and endophthalmitis ( P = 0.005, P < 0.001, P = 0.044, respectively) were risk factors for poor visual outcome., Conclusions: The initial VA, the extent of the initial ocular damage, and the presence of endophthalmitis are important prognostic factors for functional success. [ Ophthalmic Surg Lasers Imaging Retina 2024;55:434-442.] .

Background: This case mainly describes a relatively rare case of an old mineral-like corneal foreign body that existed for up to 20 years, and did not significantly affect the visual quality of the patient., Case Presentation: A 56-year-old male miner complained of right eye vision loss for 3 years, swollen and painful for 4 months. Admission examination: Best corrected visual acuity was no light perception in the right eye and 20/20 in the left eye. Anterior segment examination: A large number of spot-like grayish-brown mineral foreign bodies in the conjunctiva of the nasal conjunctiva, emulsified silicone oil floating in the anterior chamber, Corneal foreign bodies in the right eye were widely distributed in the upper cortex and the proelastic layer. There were fewer foreign bodies in the left cornea. Previous medical history, 20 years ago due to forging and burning sulphur mine explosion, resulting in a large number of ore foreign bodies in the conjunctiva of both eyes. As these corneal foreign bodies did not affect the visual quality of the patient, we adopted a conservative treatment plan, did not remove these foreign bodies, and only carried out symptomatic treatment for the patient's secondary ocular hypertension. The patient was followed up normally in the outpatient department, and no cornea-related complications occurred up to now., Conclusions: First of all, it is necessary to understand the source and nature of the foreign body in patients with corneal and conjunctival foreign body injuries. In the second, for the old corneal metal foreign body, when the patient's visual acuity is stable and there are no symptoms of corneal irritation and inflammatory reaction, it can be Conservative treatment or outpatient follow-up observation. In the end, corneal Optical coherence tomography imaging should not be ignored, which is very important for determining the depth of embedding and the location of the corneal foreign body., (© 2024. The Author(s).)

A 64-year-old male was referred for complaints of blood in tears and bloody discharge of unknown cause in the left eye. The patient was a chronic bandage contact lens (BCL) user. He had no history of recent trauma. A blood-stained BCL was present on the cornea in the left eye, which was removed. The ocular surface was dry with vascularization of the cornea. Double eversion of the upper eyelid with a Desmarre's retractor revealed a pyogenic granuloma with large papillae on the forniceal conjunctiva and a folded BCL hidden in the fornix. The folded BCL was carefully removed from the "upper fornix trap" and topical steroid eyedrops were prescribed., Competing Interests: The authors state no conflict of interest., (© 2024 The Authors.)

Introduction: Open globe injuries are a major cause of visual impairment in children, related to the severity of the trauma or secondary to induced amblyopia. Intraocular foreign bodies (IOFB) have been reported in approximately one third of cases of open globe injuries. As clinical presentation and management may differ between adults and children, data is lacking about IOFBs in children under 18years of age. The purpose of this study was to assess the clinical characteristics and visual prognosis of ocular trauma associated with intraocular foreign bodies in children., Materials and Methods: This single-center retrospective study included patients under 18years of age treated for ocular trauma with IOFB. Demographic characteristics, complete initial and final ophthalmological examination, imaging data and details of medical and surgical management were collected., Results: Fourteen patients were included (78.6% boys), with a mean age of 10.3years (min 7months-max 17years). In 92.9% of cases, patients were found to have a single IOFB, mostly metallic (71.4%). Posterior segment IOFBs were found in 50% of cases, anterior segment IOFBs in 28.6% and orbital IOFBs in 21.4%. The clinical examination permitted detection of the IOFBs in 50% of cases, while they were visible on CT scan in all cases. The mean initial visual acuity was 20/320, and the mean final visual acuity was 20/125. Endophthalmitis occurred in 2 cases (14%)., Discussion: Open globe injuries associated with IOFB are severe and sight-threatening. Localization of the IOFB in the posterior segment has a worse prognosis. CT scan is mandatory, especially in children, as the trauma history is often missing. Retinal detachment and endophthalmitis appear to be the main prognostic factors requiring urgent specialized pediatric ophthalmology management., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Purpose: The intraocular lens blocking technique described for the removal of intraocular foreign bodies emerged as a result of an effort to prevent the foreign body from being retracted into the posterior segment because of the resistance encountered while removing it from the corneal incision. However, in the technique described, in addition to the difficulty of the surgical procedure, the new concern is to create a posterior capsulorhexis according to the size of the foreign body and to pass the foreign body through the capsulorhexis., Methods: Here, the authors describe a new approach to the intraocular lens blocking technique. In this approach, the intraocular foreign body, which is held with intraocular forceps without any opening in the posterior capsule, is held in a perpendicular position to the long axis, lifted directly into the anterior chamber, and safely removed from the front of the monoblock foldable intraocular lens., Results: In all patients treated with this approach, IOFBs were successfully removed without intraoperative or postoperative complications, and postoperative intraocular lens centralization was achieved in all patients., Conclusion: This approach may provide practicality to the intraocular lens blocking technique.

Objectives: To identify the clinical features and outcomes of early vitrectomy in patients with open globe injury (OGI) and the prognostic factors for visual outcome., Methods: This retrospective observational case series included 390 eyes in 389 patients diagnosed with OGI receiving vitrectomy within four days after injury. Preoperative parameters included the injury types, wound locations, consequent tissue damages, initial visual acuity (VA), and ocular trauma score. Postoperative outcome measures included surgical procedures, retinal (re)attachment, complications, and final VA. The logistic analysis evaluated the prognostic factors for visual outcome., Results: Intraocular foreign bodies (59.2%) and penetrating injuries (28.7%) were the most common injury types. Among the 165 eyes with retinal detachment (RD), 121 (73.3%) had retinal reattachment during early primary vitrectomy, and 32 (19.4%) were repaired during a second or subsequent surgery. Thirteen eyes (3.3%) were enucleated. The final VA improved from the initial level in 207 eyes (55.2%), remained unchanged in 123 (32.8%), and decreased in 45 (12.0%). Multivariable regression revealed that the injury zone, initial VA, RD, and endophthalmitis were associated with poor visual outcomes (P < 0.05)., Conclusions: Higher zone injury, low initial VA, RD, and endophthalmitis are predictors of poor visual outcome in eyes undergoing early vitrectomy for OGI., (© 2023. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Purpose: Retained foreign objects (RFOs) can place patients undergoing cataract surgery at risk for significant vision-threatening complications. In this systematic review, we examine the characteristics, clinical outcomes, and management of RFOs originating from surgical instruments or the surgical field after routine cataract surgery., Methods: Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, we searched five databases in June 2023. The inclusion criteria were peer-reviewed, full-text, English-language articles describing RFOs after routine cataract surgery. Studies that described non-routine cataract surgeries, patients with a history of ocular trauma, or organic RFOs were excluded. Two investigators independently extracted data and appraised the methodological quality of each study using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE)., Results: Twenty-eight studies were included in our qualitative synthesis describing metal, fiber, and plastic RFOs. Typically, the RFOs were detected during surgery or slit-lamp examination. Presentations of patients with metal or fiber RFOs varied, with some being asymptomatic. Patients with plastic RFOs were usually symptomatic, often with decreased visual acuity and/or anterior chamber inflammation. Metal RFOs may have originated from metal fatigue from prolonged instrument usage and contact between surgical instruments, fiber RFOs from surgical wipes and gauzes, and plastic RFOs from instrument wrapping and intraocular lens defects. Factors such as location, biocompatibility, and secondary intraocular inflammation influenced the decision to surgically remove RFOs. Following surgical removal, the signs and symptoms resolved in most patients with RFOs. The studies' GRADE ratings indicated limitations in risk of bias and imprecision., Conclusion: The presentation and management of RFOs varied depending on the type of material. To prevent RFOs, clinicians should carefully inspect surgical instruments and packs and use fiber-free wipes, towels, and gauzes. Future studies should investigate the efficacy and cost-effectiveness of different RFO prevention strategies., (© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Introduction: Panuveitis is a serious inflammatory disease. Setae are fibers produced by many insects and plants. Many case reports have described caterpillar and spider fibers entering the eye. These hairs are covered with tiny barbs that help them enter and migrate into the eye tissue, leading to severe inflammation. Normally, they are buried mainly in the conjunctiva and cornea. However, in the present case, they entered the posterior segment of the eye, which is very rare., Case Description: A female patient presented with a complaint of repeated foreign body sensation, redness, pain, and photophobia in the left eye for 9 years following initial exposure to caterpillars. She visited the doctor in January after aggravation of symptoms. Slit-lamp examination, ultrasound biomicroscopy, ultrasound B-scan, fluorescein angiography, and indocyanine green angiography revealed the presence of a foreign body in the vitreous, which caused discomfort in the patient's left eye and subsequently, panuveitis of the left eye. The symptoms improved significantly after foreign body removal using vitrectomy. Microscopic examination revealed that the foreign body was caterpillar setae., Conclusion: Clinicians should be more vigilant about history of contact with caterpillars while examining uveitis that has recurred for many years. Identification of the root cause of the disease can ensure better treatment., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: To report a rare case of a 65 year old patient with a single caterpillar hair with localised lenticular opacity around it and no active inflammation., Observations: A single quiescent caterpillar hair embedded in the anterior lens capsule causing localised cataract around it. There was no other sign of ocular toxicosis and the patient was unaware of the presence of this intraocular foreign body., Conclusions: Caterpillar hair (also known as setae) are a common cause of ophthalmia nodosa. These setae can penetrate intraocularly with ease to cause various forms of ocular toxicosis ranging from conjunctivitis, keratitis, pars planitis, chorioretinitis to even severe vitritis warranting enucleation. As per our knowledge and experience, no case of caterpillar hair without inflammation has been reported till date. We hereby report a rare case of a 65 year old patient with a single caterpillar hair embedded in the anterior lens capsule causing localised cataract around it without any active inflammation. In our opinion, if the eye is quiescent, the patient should be kept on close and long term follow-up and active intervention can be undertaken at the first instance of inflammation or if cataract progresses., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Competing Interests: Competing interests: None declared.

Aim: To report the clinical settings and factors predicting outcomes in scleral tears with concurrent retained intraocular foreign bodies METHODS: All cases with scleral and corneoscleral wounds with retained intraocular foreign bodies (RIOFB) from January 2014 to January 2021 were retrospectively analysed. Favourable anatomic outcome was defined as presence of globe integrity, attached retina, absence of hypotony and active inflammation at last visit. Favourable functional outcome was defined as final visual acuity (VA) > 20/200., Results: Total 139 eyes were included. Mean age was 30.66 ± 13.32 years (median 29 years, IQR 17). Penetrating trauma accounted for 87.1%, rupture for 5.8%, perforation for 7.2%. In 5.8% of the eyes the injury involved zone I extending till Zone II while in 66.9% it involved Zone II and in 27.3% in Zone III. Snellen visual acuity at presentation was logMAR 2.97 ± 1.01 and at last visit was logMAR 2.38 ± 1.45 (p < 0.0001). Time between presentation and repair was 13.93 ± 19.56 h (median 7.6 h, IQR 17.17). Favourable functional outcome was seen in 34.5% eyes and 2/3rd achieved favourable anatomic outcome. Absence of endophthalmitis (OR = 6.25, p = 0.003) and ability to remove the foreign body (OR = 7.05, p = 0.003) were associated with a favourable anatomic outcome. Better presenting Snellen visual acuity (OR = 2.77, p = 0.003), manifest scleral tear (OR = 3.36, p = 0.04), and absence of endophthalmitis (OR = 50, p = 0.0009) were associated with a favourable functional outcome., Conclusion: A third of the cases achieved favourable visual outcome while 2/3rd achieved favourable anatomic outcome. Absence of endophthalmitis is an important factor predicting both., (© 2023. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Background: A novel method for trapping voles is the use of pistol-like explosive tools loaded with bolt-action ammunition. When triggered the vole is killed by the very high gas pressure created. Accidental releases can result in facial and/or eye injuries. The aim of this work was to describe the injury pattern in the patient and to experimentally verify whether there is a risk of penetrating eye injuries., Methods: Two emergency patients presented to our eye clinic with eye injuries after unintentional triggering of the explosive trap. Based on the new pattern of injury noted, experiments were performed on enucleated porcine eyes to determine the possible severity. For this purpose, a vole trap was clamped in a holder and loaded with a Cal. 9 × 17 mm cartridge in each case. In front of the muzzle opening, 3 pig eyes each were fixed on Styrofoam at a distance of 20, 40, 60 and 80 cm. The foreign body indentations in the cornea were visualized and measured by spectral domain optical coherence tomography (SD-OCT). The pig eyes were then dissected and searched for foreign bodies using microscopy. The SD-OCT images of an injured patient were also included for human comparison., Results: On patient examination, in addition to the usual fine gunshot marks on the face and conjunctiva/eye area, wax-like, larger and heavier particles of approximately 0.1-0.2 mm in size were found, which originated from the cartridge end cap. Removal of these foreign bodies, some of which were injected more deeply into the cornea, conjunctiva, and tenon, is much more difficult and extensive than in usual blast trauma. There was no evidence of intraocular foreign bodies in either patient. Likewise, no intraocular foreign bodies could be detected experimentally in any pig eyeball (n = 12). Remnants of the wax-like cartridge end were found deeply penetrating into the corneal stroma. The maximum penetration depth measured against the total corneal thickness was 46% at 20 cm device distance and decreased with greater distance to the vole trap (penetration depth at 40 cm at 37%, at 60 cm at 28% and at 80 cm at 19%). For comparisons on the human eye, a penetration depth of 54% was measured at a distance of about 40 cm. In pig eyes the number of foreign bodies per cm 2 decreased with increasing distance from the vole trap (mean: n = 174 foreign bodies, FB, at 20 cm distance, n = 46 FB at 40 cm, n = 23 FB at 60 cm, and n = 9 FB at 80 cm). The largest penetrating foreign bodies measured a mean of 383 ± 43 μm with a maximum of 451 μm., Conclusion: New vole traps with gas-powered mechanisms result in larger deeply penetrating wax-like foreign bodies in the cornea, conjunctiva, and tenon of the eye, which are difficult to remove and only surgically possible. Despite the significant explosion during triggering, there was no evidence of penetrating ocular injury from the foreign bodies either in the patient or experimentally in the pig eyes. Safety goggles should be worn when handling the traps to avoid penetration of foreign bodies into the eye., (© 2023. The Author(s).)

A 55-year-old woman presented with a stromal wooden foreign body (FB) in the left cornea. The deep corneal stroma wooden FB was removed using vitreoretinal FB forceps as a scoop. In this innovative technique, a 26-gauge needle was used to open the track of the wooden FB. The FB was trapped in the concavity of one limb of the vitreoretinal FB forceps. The vitreoretinal forceps were gradually withdrawn and the FB was removed. The patient was treated with gatifloxacin and voriconazole six times, and atropine 1% three times daily. The patient did not develop infiltrate or hypopyon in 2 weeks. After 2 weeks, gatifloxacin and voriconazole were reduced to four times a day; and atropine to two times a day. After 6 weeks topical medication was stopped. The patient achieved a best-corrected visual acuity (OS) of 6/9 at 8 weeks and maintained it through 7 months of follow-up., (Copyright © 2023 Copyright: © 2023 Indian Journal of Ophthalmology.)

Purpose: To evaluate the efficiency and safety of using an intraocular foreign body forceps with two nitinol loops at its tip to capture and chop dropped nucleus (DN) during vitrectomy as an alternative method and to evaluate the outcomes and complications of this surgical technique., Methods: The eyes that underwent 23-gauge vitrectomy with removal of DN using nitinol forceps with a minimum follow-up time of 1 year are included in this study. The efficiency of surgical technique and anatomical and functional results with complications is recorded., Results: Nine patients with a mean age of 73.11 ± 2.15 years were included in this study. The mean time between DN and vitrectomy was 7.67 ± 3.74 (5-14) days. In all eyes, DN was easily chopped and removed with aspiration. Argon laser photocoagulation was performed in 4 eyes (44.44%) during surgery. All eyes were followed up for a mean time of 21.11 ± 12.36 (12-48) months. The mean preoperative best-corrected visual acuity increased significantly during the postoperative follow-up ( P < 0.001). No complications related to the cataract surgery or DN removal were observed., Conclusion: Surgical removal of DN with the help of these forceps with nitinol loops is found to be safe and effective in this study. This method avoids ultrasonographic energy and enables 23-gauge vitrectomy without a fragmatome.

Purpose: To describe a "magnetic conduction" technique for the removal of metallic intraocular foreign bodies (IOFBs) in the posterior segment combined with cataract extraction and pars plana vitrectomy and to report its outcomes., Methods: We retrospectively analyzed the data of 42 eyes of 42 patients with posterior metallic IOFBs between April 2020 and February 2022. In all patients, cataract extraction was combined with pars plana vitrectomy. With an external magnet, the IOFBs were captured by a magnetized vitrectomy cutter, delivered to the anterior chamber, and then extracted through a corneal phacoemulsification incision., Results: All patients were men, with a mean age of 45.6 ± 10.7 years. The mean size of the IOFBs was 3.5 ± 1.7 mm (range, 1.5-8.9 mm) in their longest dimension. A final best-corrected visual acuity of 20/200 or better was noted in 24 of 42 patients (57.1%). Postoperatively, recurrent retinal detachment was seen in three eyes. There were no other intraoperative or postoperative complications., Conclusion: The "magnetic conduction" technique combined with phacovitrectomy is a safe and feasible approach to removing IOFBs in the posterior segment.

Purpose: To assess clinical features, visual outcomes, and setting of mobile battery blast-induced eye injuries in children., Methods: Retrospective case sheets of children with mobile battery blast injuries were reviewed at a tertiary eye care center from January 2015 to March 2022. We noted the mode of injury, battery status, and clinical presentation and analyzed the treatment outcomes., Results: The study included 14 eyes of 11 patients. Three patients (27%) had bilateral ocular injuries. The most common reasons for the blast were wiring a bulb to the battery or charging the battery with a universal mobile charger, seen in four cases each. Three eyes had closed-globe injuries (CGIs), whereas 11 had open-globe injuries (OGIs). Of the 11 eyes with OGI, four also had a retained intraocular foreign body (IOFB). Only four (36%) eyes having OGI could achieve vision better than 6/60. All three eyes with CGIs developed secondary glaucoma, and two underwent trabeculectomy. However, the visual prognosis was better (>6/36) in eyes with CGI. Overall, mean visual acuity at the final follow-up was improved to 1.41 ± 1.14 logMAR from 2.32 ± 0.76 logMAR at presentation. This was also found to be statistically significant with a P value of 0.02., Conclusion: Battery blast-induced ocular injuries, although rare, often lead to poor outcomes. Apart from charging, playing with discarded or damaged batteries was a common reason for battery blasts in our series., (Copyright © 2023 Copyright: © 2023 Indian Journal of Ophthalmology.)

Purpose: To describe a case of a 44-year-old man with ocular trauma after a mine explosion. From the moment of the injury, the patient reported significant visual impairment (no perception of light in the right eye and a perception of light without localization in the left eye). The patient was diagnosed with a double-sided penetrating corneal scleral wound and traumatic cataract, retinal detachment, and intraocular foreign bodies after a battlefield mine explosion., Methods: The three-stage procedure, consisting of using soft contact lens as temporary keratoprosthesis, vitrectomy, and penetrating keratoplasty, was performed in the damaged eye., Results: A soft contact lens allowed for excellent visualization of the posterior segment during vitrectomy. At the 1-month follow-up, the eye that was operated on could sense light. The corneal transplant remained translucent, and the retina was attached., Conclusion: The described method, when performed by an experienced surgeon, may aid in simultaneously treating coexisting corneal opacification and vitreoretinal disorders.

We describe the double reverse overlapping scleral trapdoor (DROST) technique, a novel minimally invasive technique for the removal of very anterior intraocular foreign bodies without the need of pars plana vitrectomy. [ Ophthalmic Surg Lasers Imaging Retina 2023;54:600-602.] .

Purpose: Exogenous endophthalmitis (ExE) results from microbial infection as a complication of ocular surgery, penetrating ocular trauma, and intraocular foreign bodies. We herein review the classification of ExE, etiological agents, differential diagnosis and therapeutic challenges., Methods: Narrative Literature Review., Results: Identification of the causative agent through ocular fluid analysis is central in the diagnostic work-up of ExE. Prompt intravitreal antimicrobial therapy is key to successful management of ExE and vitrectomy is essential in severe cases. In culture-negative cases, and in the presence of specific features, a diagnosis of sterile intraocular inflammation or toxic syndrome should be suspected., Conclusion: Strict adherence to treatment guidelines may improve outcomes of ExE, however the ultimate prognosis, especially in severe cases, may depend more on the virulence of the causative organism and associated ocular complications. Accurate differential diagnosis and effective treatment are crucial elements in the management and prognosis of non-infectious masquerades of ExE.

Background: The grease-guns injury is an uncommon injury to the orbit. We present the twelfth and thirteenth cases of grease-gun injury to the orbit to be reported in the English language literature since 1964. Here we discus and review the presentation, investigation, and treatment of this unusual trauma., Case Presentation: Case 1 was a 29-year-old man who presented 1 day after a grease-gun injury of the left orbit with severe pain, marked periorbital swelling, and proptosis. Computed tomography (CT) revealed penetration of grease into his left orbit. Following surgical removal, proptosis decreased. The limitation of extraocular movement and loss of visual acuity to finger count was discovered after the initial surgery. Motility gradually returned. Visual acuity recovered after phacoemulsification, capsular tension ring and intraocular lens implantation for traumatic cataract and subluxation. Case 2 was a 6-year-old boy who was referred 2 months after a grease-gun injury for worsening swelling with sinus, necrosis and slight ptosis of the upper left eyelids. This is a case of orbital chronic inflammation from grease-gun injuries masquerading as orbital cellulitis. The imaging findings of CT and magnetic resonance imaging (MRI) are not typical. Surgical exploration and debridement was inevitable and actually relieved the symptoms., Conclusions: Grease-gun injuries can damage the orbit in different degrees. Careful history inquiry and taking is important to establish the diagnosis. Imaging examinations using CT or MRI are helpful to determine depth of trauma and foreign bodies in the orbit at diagnosis. We suggest that surgical exploration and debridement is a key step in the management., (© 2023. The Author(s).)

A conjunctival foreign-body (FB) granuloma may result following trauma with synthetic and non-synthetic materials including organic and non-organic objects. Children usually manifest with FB granulomas that develop due to inoculation of FBs from soft toys, blankets or woollen clothes. Encapsu- lation of these FBs following a granulomatous inflammatory response results in a nodular swelling in the conjunctiva. Reports of a wooden FB granuloma in the conjunctiva in children are anecdotal. A 5-year-old boy suffered an un- witnessed direct ocular trauma to his left eye (OS) with a wooden arrow while playing. He developed redness and nodular swelling at the inferotemporal aspect of the OS without any visual complaints. The diagnosis of a wooden FB granuloma is a challenge to ophthalmologists and may go undetected in children who neglect their symptoms. It characteristically presents as a unilateral conjunctival nodule. Surgical excision is the definitive management. However, spontaneous extrusion of the FB might be observed due to protective blinking and tearing mechanisms in the eye.

Purpose: To describe the construction of a novel intraocular snare and evaluate its effectiveness in intraocular foreign body (IOFB) removal., Method: This is a retrospective consecutive case series. Five patients underwent pars plana vitrectomy and IOFB removal using the intraocular snare constructed from modified flute needle., Results: All IOFBs were successfully engaged and removed with the snare on the first attempt. Three of the 5 cases (60%) enjoyed good visual outcome (0.4-1.0) postoperatively. No complication related to the use of the snare was encountered in this case series., Conclusion: Intraocular foreign body snare is simple, safe, and effective in IOFB removal.

Background: Orbital injuries with organic foreign bodies are a clinical challenge as they can cause a variety of complications and sometimes lead to irreversible visual impairment., Material and Methods: We report five consecutive cases of patients with organic orbital foreign bodies who presented between 2012 and 2022. Documented parameters include age, gender, time of injury, mechanism of injury, best-corrected visual acuity (BCVA), presence of pain, restriction of motility, performed imaging, location and type of foreign body, treatment and complications., Results: The mean patient age was 61.8 ± 32.3 years and the gender ratio was 4:1 (female:male). In 4 cases the injury had been reported on average 4.6 days (0/14 days min/max) previously. Best corrected visual acuity at first presentation was 0.5 ± 0.2 decimal and after a mean follow-up of 12.7 months (0.5/38 months min/max) at last presentation 0.67 ± 0.3 decimal (p = 0.2). The reason for initial presentation was pain (n = 3) and/or double vision (n = 2). All patients underwent computer tomography (CT). The diagnosis was confirmed in two cases by means of CT. In all five cases the foreign body material could be completely surgically removed, while one patient needed repeated surgery due to retained foreign body material. The organic foreign body material included wood (4) and wax (1). In two cases, a foreign body-induced infection was successfully treated with systemic antibiotics. There were no other complications., Conclusion: In orbital trauma a thorough wound exploration must be performed, especially if the mechanism of injury is uncertain and residual foreign bodies or a perforation injury cannot be excluded. The imaging of choice is CT, which may have to be performed again in the postoperative course., (© 2022. The Author(s).)

Background: A patient with a retained intraocular metallic foreign body post-trauma was taken up for vitrectomy and intraocular foreign body removal. Unfortunately, the intraocular magnet was not available at the moment on the table! How a little bit of creativity and innovative thought helped us tide over this crisis is the content of this video., Purpose: To demonstrate magnetization of a metallic surgical instrument for temporary use in the event of unavailability of the intraocular magnet for intraocular foreign body removal., Synopsis: A ferromagnetic substance can be magnetized temporarily using an existing magnet. We obtained a general-purpose magnet and wrapped it in sterile plastic, using which we magnetized normal intraocular forceps and a Micro Vitreo Retinal (MVR) blade by giving about 20-30 strokes over the magnet in a single direction. This aligned the magnetic domains in the metal in a parallel fashion. These Do It Yourself (DIY)- magnetic instruments were then effectively utilized to remove the metallic intraocular foreign body., Highlights: The video showcases effectively harnessing the available resources and tiding over the dearth of a necessary instrument, with the right use of an innovative idea and some creativity!., Video Link: https://youtu.be/QtRC-AK5FLU., Competing Interests: None

Purpose: To evaluate the effectiveness of loading the vitreous cavity with a cohesive ophthalmic viscosurgical device in aiding the removal of the posterior segment intraocular foreign body (IOFB)., Methods: Seven consecutive patients underwent a small-gauge vitrectomy due to eye trauma with the IOFB between January 2019 and December 2019. The IOFB removal was initiated after total filling the vitreous cavity with the ophthalmic viscosurgical device (Eyefill C or Bio-Hyalur Plus) to facilitate maneuvering and slow the descent in cases of the unintendedly released IOFBs. The eye examination was performed at presentation and at 1 day, 7 days, 1 month, and 3 months after surgery. The best-corrected visual acuity and intraocular pressure were evaluated., Results: In all eyes, IOFBs were elevated into the center of the vitreous cavity and could be securely gripped while suspended in the ophthalmic viscosurgical device to allow the surgeon for successful and harmless removal. In the 3-month follow-up, the best-corrected visual acuity was 20/20 in 5 patients and 20/25 in 2 patients. In the early postoperative period, the elevation of intraocular pressure did not occur. No patient developed endophthalmitis., Conclusion: The authors demonstrated that this uncomplicated technique is an effective surgical option for more reliable removal of posterior segment IOFBs.

Background: Ocular trauma is complex and varied, and some occult intraocular foreign bodies (IOFBs) can lead to uncommon symptoms and signs. We report a case of rhegmatogenous retinal detachment (no obvious wound, no pain, no intraocular infection or other symptoms) caused by an occult intraocular aluminium foreign body, which could have been easily missed., Case Presentation: A 42-year-old male presented to the outpatient department of our hospital complaining of fluttering black dots and decreased vision in his left eye that began 3 months earlier. He was diagnosed with "floaters" at a community hospital. He denied a history of ocular trauma or previous surgery. The cornea and lens of the left eye were clear. A small patch of pigmentation was noted in the temporal sclera. Fundoscopy revealed macula-off retinal detachment. After mydriasis, elliptical holes were seen in the peripheral retina at 2:30, and a suspicious hyperreflective strip was found under the anterior lip of the retina by Goldmann three-mirror contact lens examination; the strip was confirmed to be an IOFB by orbital CT. The IOFB was removed through pars plana vitrectomy without any complications., Conclusion: Unlike iron and copper IOFBs, aluminium IOFBs are more inert and more likely to be missed. For people with special occupations (construction workers, mechanics, etc.), when abnormal pigmentation of the sclera is found, the possibility of foreign bodies in the eye should be considered. In the process of disease diagnosis and treatment, it is necessary to ask for a detailed history, including occupation history and practice, and perform careful physical and targeted examinations. Such comprehensive analysis regarding the above information will minimize the chance of missed diagnosis.Awareness of occult IOFB in high risk occupations and prompt referral to a retinal surgeon is of outmost importance., (© 2023. The Author(s).)

Traumatic infectious endophthalmitis refers to the inflammation of one or multiple layers of the eyeball wall and intraocular contents caused by pathogen invasion after open globe injury. Its incidence rate is about 4% to 16%. There are various factors related to the occurrence, development and prognosis of traumatic infectious endophthalmitis, including the types of ocular trauma, the properties of pathogens, the presence of intraocular foreign body and the treatment timing. Reasonable preventive measures, accurate diagnosis and timely and effective treatment are critical for the recovery of visual function and even the preservation of the eyeball in high-risk patients. In order to further clarify and standardize the prophylaxis and management of traumatic infectious endophthalmitis, the experts of the China Ocular Trauma Society have reached consensus opinions after discussions, thus providing reference for ophthalmologists in clinical practice.

Purpose: To describe the demographics, clinical profile, and outcomes of ocular siderosis in patients presenting to a multi-tier ophthalmology hospital network in India., Methods: This cross-sectional and hospital-based study included 3,082,727 new patients who presented between August 2010 and December 2021. Patients with a clinical diagnosis of ocular siderosis in at least one eye were included., Results: Overall, 58 eyes of 57 patients (0.002%) were diagnosed with ocular siderosis. The majority were men (96.49%) and had unilateral (98.25%) affliction. The most common age group at presentation was during the third decade of life with 24 patients (42.11%). A clear history of ocular trauma was documented in 47 patients (81.03%). Major clinical signs included corneal pigment deposition in nearly half of the eyes (27/58 eyes, 46.55%), corneal scar (20/58 eyes, 34.48%), cataract (22/58 eyes, 37.93%) and retinal detachment (11/58 eyes, 18.96%). The intraocular foreign body (IOFB) was anatomically localized in a majority of the eyes (i.e., 45/58 eyes, 77.59%). The most common location of the IOFB was in the posterior segment (22/58 eyes, 37.93%). The eyes that underwent a vitreoretinal surgery with removal of IOFB had a slightly better BCVA (1.0 ± 1.01) when compared to eyes with non-removal of IOFB (1.58 ± 1.00)., Conclusion: Ocular siderosis is a rare sight-threatening entity, with half of the affected eyes exhibiting severe visual impairment. Majority of the eyes in ocular siderosis will have a detectable IOFB. Surgical removal of IOFB may lead to a better visual gain when compared to non-removal., Competing Interests: None

Introduction: Open globe injury (OGI) is a rare but serious condition that carries with it a high rate of morbidity., Objective: This review highlights the pearls and pitfalls of OGI, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence., Discussion: OGI refers to full-thickness injury to the layers of the eye. OGI can be caused by blunt or sharp trauma, and subtypes include penetration, perforation, intraocular foreign body (IOFB), globe rupture, or mixed types. OGI is more common in males and usually secondary to work-related injury, but in women it is most commonly associated with falls. Emergency clinicians should first assess for and manage other critical, life-threatening injuries. Following this assessment, a thorough eye examination is necessary. Computed tomography (CT) may suggest the disease, but it cannot definitively exclude the diagnosis. While point-of-care ultrasound (POCUS) is highly sensitive and specific for some findings in OGI, its use is controversial due to potential globe content extrusion. Management includes protecting the affected eye from further injury, preventing Valsalva maneuvers that could extrude ocular contents, updating tetanus vaccination status, administering broad-spectrum antibiotics, and ophthalmology consultation for surgical intervention to prevent the sequelae of blindness and endophthalmitis., Conclusion: An understanding of OGI can assist emergency clinicians in diagnosing and managing this sight-threatening traumatic process., Competing Interests: Declaration of Competing Interest None., (Published by Elsevier Inc.)

Facial foreign body (FB) is common after trauma, but iatrogenic orbital FB is a rare and unexpected complication of facial FB removal surgery. We present the case of a 43-year-old man with a glass FB in his nose. During the operation, this FB broke into two pieces, and the larger one pierced into the left orbit, close to the eyeball. A three-dimensional (3D) model was made that accurately recreated the shape and position of the FB in the orbit, according to which the FB was removed. 3D-printing technology is a great tool when dealing with complex facial FB.