To evaluate the diagnostic accuracy of clinical eye examination and radiographic imaging in the identification of intraocular foreign bodies (IOFBs) in open-globe traumatic injuries.
Methods
This was a retrospective chart review of open-globe traumatic injuries with IOFBs presenting to University Hospital (UH) at New Jersey Medical School between 1998 and 2008.
Results
A total of 527 patients with traumatic open globe injuries presented to UH, Newark, New Jersey, USA, between 1998 and 2008. Of these, 74 patients had surgically confirmed IOFBs. Mean age of patients with traumatic open globe injury and an IOFB was 33 years (range, 8-69 years); mean follow-up was 17.6 months (range, 1 day–90 months). Foreign bodies were identified as glass (13), metal (58), wood (1), plastic (0), and other (2). There were 24 anterior segment (AS) IOFBs, 45 posterior segment (PS) IOFBs, and 5 noted in both segments. Clinical eye examination at presentation identified an IOFB in 34 (45.6%) of 74 patients. B-scan echography revealed an IOFB in 14 (51.9%) of 27 cases. Computed tomography scan of the orbits identified IOFBs in 56 (94.9%) of 59 cases. Clinical eye examination was performed in all (100%) patients. B-scan was performed only when posterior segment pathology was suspected. Computed tomography scan was performed when an IOFB or orbital fracture was suspected.
Conclusions
Computed tomography scan was the most reliable method for identifying IOFBs in patients presenting with open globe injuries in comparison to clinical eye examination and B-scan echography. This result was consistent regardless of IOFB location within the globe.
ParverL.M., DannenbergA.L., BlacklowB., FowlerC.J., BrechnerR.J., TielschJ.M.Characteristics and causes of penetrating eye injuries reported to the National Eye Trauma System Registry, 1985-91.Public Health Rep1993; 108: 625–32.
4.
YehS., ColyerM.H., WeichelE.D.Current trends in the management of intraocular foreign bodies.Curr Opin Ophthalmol2008; 19: 225–33.
5.
ColemanD.J., LucasB.C., RondeauM.J., ChangS.Management of intraocular foreign bodies.Ophthalmology1987; 94: 1647–53.
6.
De JuanE.Jr, SternbergP.Jr, MichelsR.G.Penetrating ocular injuries: types of injuries and visual results.Ophthalmology1983; 90: 1318–22.
7.
PunnonenE., LaatikainenL.Prognosis of perforating eye injuries with intraocular foreign bodies.Acta Ophthalmol1989; 67: 483–91.
8.
ShockJ.P., AdamsD.Long-term visual acuity results after penetrating and perforating ocular injuries.Am J Ophthalmol1985; 100: 714–8.
MesterV., KuhnF.Intraocular foreign bodies.Ophthalmol Clin North Am2002; 15: 235–42.
12.
KuhnF., CollinsP., MorrisR., WitherspoonC.D.Epidemiology of motor vehicle crash-related serious eye injuries.Accid Anal Prev1994; 26: 385–90.
13.
ChackoJ.G., FigueroaR.E., JohnsonM.H., MarcusD.M., BrooksS.E.Detection and localization of steel intraocular foreign bodies using computed tomography: a comparison of helical and conventional axial scanning.Ophthalmology1997; 104: 319–23.
PieramiciD.J., Au EongK.G., SternbergP.Jr, MarshM.J.The prognostic significance of a system for classifying mechanical injuries of the eye (globe) in open-globe injuries.J Trauma2003; 54: 750–4.
21.
PieramiciD.J., SternbergP.JrAabergTMSr, , The Ocular Trauma Classification Group. A system for classifying mechanical injuries of the eye (globe).Am J Ophthalmol1997; 123: 820–31.
22.
WongT.Y., KleinB.E., KleinR.The prevalence and 5-year incidence of ocular trauma: The Beaver Dam Eye Study.Ophthalmology2000; 107: 2196–202.
23.
MackiewiczJ., KrupskiW., HaszczD., ZagórskiZ.Localization of intraocular foreign bodies using computed tomography.Klin Oczna2001; 103: 21–3.
24.
GasterR.N., DudaE.E.Localization of intraocular foreign bodies by computed tomography.Ophthalmic Surg1980; 11: 25–9.
25.
TateE., CupplesH.Detection of orbital foreign bodies with computed tomography: current limits.AJR Am J Roentgenol1981; 137: 493–5.
26.
GuhaS., BhendeM., BaskaranM., SharmaT.Role of ultrasound biomicroscopy (UBM) in the detection and localisation of anterior segment foreign bodies.Ann Acad Med Singapore2006; 35: 536–45.
LiS.Y., ShiD.P.Comparison of ultrasound biomicroscopy and CT in diagnosis of anterior segment intraocular foreign body.Zhonghua Yan Ke Za Zhi2008; 44: 229–32.
29.
LakitsA., ProkeschR., ScholdaC., BankierA.Orbital helical computed tomography in the diagnosis and management of eye trauma.Ophthalmology1999; 106: 2330–5.
30.
TopilowH.W., AckermanA.L., ZimmermanR.D.Limitations of computerized tomography in the localization of intraocular foreign bodies.Ophthalmology1984; 91: 1086–91.
31.
ZhuY., ZhangX.F., ShengY.J.Combining diagnosis of IOFB and complications with multiple image-related methods.Zhonghua Yan Ke Za Zhi2003; 39: 520–3.
32.
KubalW.S.Imaging of orbital trauma.Radiographics2008; 28: 1729–39.
YamashitaK., NoguchiT., MiharaF.An intraorbital wooden foreign body: description of a case and a variety of CT appearances.Emerg Radiol2007; 14: 41–3.
35.
GorD.M., KirschC.F., LeenJ., TurbinR., Von HagenS.Radiologic differentiation of intraocular glass: evaluation of imaging techniques, glass types, size, and effect of intraocular hemorrhage.AJR Am J Roentgenol2001; 177: 1199–203.
WoodcockM.G., ScottR.A., HuntbachJ., KirkbyG.R.Mass and shape as factors in intraocular foreign body injuries.Ophthalmology2006; 113: 2262–9.
38.
LakitsA., ProkeschR., ScholdaC., NowotnyR., KaiderA., BankierA.Helical and conventional CT in the imaging of metallic foreign bodies in the orbit.Acta Ophthalmol Scand2000; 78: 79–83.
39.
DassA.B., FerroneP.J., ChuY.R., EspositoM., GrayL.Sensitivity of spiral computed tomography scanning for detecting intraocular foreign bodies.Ophthalmology2001; 108: 2326–8.
40.
FigueiraE.C., FrancisI.C., WilcsekG.A.Intraorbital glass foreign body missed on CT imaging.Ophthal Plast Reconstr Surg2007; 23: 80–2.
41.
LagallaR., ManfrèL., CaroniaA., BencivinniF., DurantiC., PonteF.Plain film, CT and MRI sensibility in the evaluation of intraorbital foreign bodies in an in vitro model of the orbit and in pig eyes.Eur Radiol2000; 10: 1338–41.
