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 Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 4  |  Issue : 2  |  Page : 60-62

Open globe injury with intraocular foreign body and traumatic cataract


Classified Specialist (Ophthalmology), Military Hospital, Jodhpur, Rajasthan, India

Date of Web Publication22-Mar-2016

Correspondence Address:
Dr. Santosh Kumar
Military Hospital, Jodhpur - 342 010, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1597-1112.179221

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  Abstract 

Penetrating ocular trauma is an important cause of visual loss in children and young adults. The fate of the traumatized eye depends on the treatment adopted, with early reporting and appropriate surgical management reducing the visual loss. With the use of modern diagnostic techniques, surgical approaches, and rehabilitation, many eyes can be salvaged with retention of vision. We report a patient who presented with sudden visual loss, corneal laceration, large foreign body, and who subsequently developed a traumatic cataract. Following a successful management, the patient's visual acuity improved from 1/60 at presentation to 6/9 at discharge.

Keywords: Intraocular foreign body, open globe injury, traumatic cataract


How to cite this article:
Kumar S. Open globe injury with intraocular foreign body and traumatic cataract. Afr J Trauma 2015;4:60-2

How to cite this URL:
Kumar S. Open globe injury with intraocular foreign body and traumatic cataract. Afr J Trauma [serial online] 2015 [cited 2021 Apr 21];4:60-2. Available from: https://www.afrjtrauma.com/text.asp?2015/4/2/60/179221


  Introduction Top


Penetrating ocular trauma is an important cause of visual loss in children and young adults. The fate of the traumatized eye depends on the treatment adopted with early reporting and appropriate surgical management reducing the visual loss. It has been estimated that 90% of all ocular injuries are preventable. [1] With the use of modern diagnostic techniques, surgical approaches, and rehabilitation, many eyes can be salvaged with retention of vision.


  Case Report Top


A 23-year-old male presented to the emergency department following a trauma, right eye, of about 4 h duration. The patient was working on a heavy military vehicle, and some metallic part of the vehicle hit his right eye. This was followed by severe pain, watering, sudden loss of vision, and difficulty in opening the affected eye. The patient reported to the local primary health center wherein a provisional diagnosis of severe injury, right eye, with presumably a metallic foreign body was made. He received injection Tetanus Toxoid and stat dose of injection cefotaxime 1 g. The patient was transferred urgently to our eye center. On examination, the visual acuity (VA) in the right eye was 1/60, and there was associated corneal laceration of about 4 mm in length in paracentral part at 2'O clock with embedded metallic foreign body whose outer end was seen at the corneal surface. The foreign body had injured other intraocular structures including iris and lens. There was also associated hyphema and shallow anterior chamber (AC). The left eye was essentially normal with VA of 6/6 and intraocular pressure of 16 mmHg as measured with a noncontact tonometer.

The patient underwent immediate corneal repair along with the removal of large foreign body under general anesthesia. The foreign body measured 7 mm in length [Figure 1]. The AC was reformed with air through a side port entry [Figure 2]. Intraoperatively, the patient also had immature traumatic cataract whose extraction was deferred to allow it to mature and more importantly for ocular inflammation to subside [Figure 3]. The specimen of the metallic intraocular foreign body was sent for microscopy, culture/sensitivity, which was later reported as sterile.
Figure 1: Removed intraocular metallic foreign body (7 mm)


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Figure 2: Anterior chamber reformed with air bubble


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Figure 3: Traumatic cataract


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Postoperatively, the patient was treated with intravenous cefotaxime 1 g 12 hourly for the next 5 days, along with tablet prednisolone 50 mg orally daily, on a tapering basis for the next 4 weeks. Furthermore, the patient had topical 1% prednisolone 2 hourly, 0.5% moxifloxacin 6 hourly, 2% homatropine 8 hourly, and 0.5% timolol 12 hourly. Topical timolol and homatropine were given for 1 week, whereas topical prednisolone and moxifloxacin were given for 4 weeks in tapering doses.

After 4 weeks, when ocular inflammation stabilized, the patient had cataract surgery. Preoperatively, ultrasonography (USG) B-scan was done to rule out any remaining foreign body and any retinal pathology. The USG B-scan was essentially normal. The patient underwent phacoemulsification with hydrophobic acrylic foldable intraocular lens (IOL) implantation. Postoperatively, the patient was treated with topical 1% prednisolone 2 hourly along with 0.5% moxifloxacin 6 hourly, which was tapered over a period of 4 weeks. The patient was reviewed weekly and at the end of 4 weeks VA was 6/18 which improved to 6/9 with refraction of −0.75/−1.5 cyl × 110° by spectacle correction [Figure 4].
Figure 4: Follow-up at 4 weeks postcataract surgery with posterior chamber intraocular lens


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  Discussion Top


Ocular trauma is a common cause of monocular blindness and visual impairment worldwide with about 1.6 million people being bilaterally blind and a further 19 million suffering from monocular blindness. [2] It is more commonly seen in males (male to female ratio 4:1) and at a much younger age (average age, 36 years) than in females (average age, 73 years). [3] The cornea and corneoscleral regions are the most common sites of injury due to the greater exposure of these structures to impact. [4] The most common causes of ocular injuries are either work-related or chance events. [4]

Ocular trauma can cause cataracts. [5] The methods used to evaluate the visual outcome in eyes managed for traumatic cataracts, and senile cataracts are similar, but the damage to other ocular tissues due to trauma may compromise the visual gain in eyes operated on for traumatic cataracts. Hence, the success rates may differ between the eyes with these two types of cataracts.

In our case, an intraocular foreign body was present as up to 40% of eyes with open-globe injuries are known to be associated with at least one foreign body. [6] In these cases, early primary surgical repair under general anesthesia is preferred, [7] and same was followed in our case. Postoperatively, the patient was managed with prophylactic systemic antibiotics and steroids in high doses to prevent endophthalmitis and to control ocular inflammation, respectively. [7],[8] In a case of ocular injury, ocular inflammation needs to be controlled at the early stage to prevent irreversible damage to ocular tissue and loss of vision. Systemic steroids were, hence, preferred over nonsteroidal anti-inflammatory drug (NSAID) due to their better and faster anti-inflammatory effects as compared to NSAID. The antifungal treatment was not given, as the fungal pathogens were not suspected since it was a metallic foreign body and not a vegetative one. Furthermore, the report of microscopy and culture/sensitivity was sterile. The management of traumatic cataract after a gap of 4 weeks was to stabilize the internal milieu, which led to an excellent visual recovery. The VA of the patient improved from 6/18 to 6/9 with a refraction of − 0.75/−1.5 cyl × 100° spectacle correction. The residual refractive error could be explained by corneal astigmatism caused due to corneal repair and possibly inadequate IOL power. We were able to successfully manage our case because the timely operative intervention was done, and all possible precautions were taken to prevent any probable complications.


  Conclusion Top


Penetrating ocular injury includes a challenge to salvage useful vision in injured eye. Prevention, early presentation, and proper management help to save vision and early rehabilitation of the patient. In this particular case, the injury occurred at a remote place far from our hospital. The importance of medical and paramedical staff at primary healthcare center cannot be ignored as they were the first to diagnose the condition correctly and made immediate referral to our center without any delay. They also ensured that the patient was kept nil orally so as to allow early surgical intervention. This shows the importance of an early evacuation in all these cases, which is of paramount importance in ensuring a successful outcome.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
National Society to Prevent Blindness. Fact Sheet. National Society to Prevent Blindness: New York; 1980.  Back to cited text no. 1
    
2.
Lima-Gómez V, Blanco-Hernández DM. Expected effect of treatment on the rate of visual deficiency after ocular trauma. Cir Cir 2010;78:302-9.  Back to cited text no. 2
    
3.
Cillino S, Casuccio A, Di Pace F, Pillitteri F, Cillino G. A five-year retrospective study of the epidemiological characteristics and visual outcomes of patients hospitalized for ocular trauma in a Mediterranean area. BMC Ophthalmol 2008;8:6.  Back to cited text no. 3
    
4.
Jafari AK, Anvari F, Ameri A, Bozorgui S, Shahverdi N. Epidemiology and sociodemographic aspects of ocular traumatic injuries in Iran. Int Ophthalmol 2010;30:691-6.  Back to cited text no. 4
    
5.
Khatry SK, Lewis AE, Schein OD, Thapa MD, Pradhan EK, Katz J. The epidemiology of ocular trauma in rural Nepal. Br J Ophthalmol 2004;88:456-60.  Back to cited text no. 5
    
6.
Thompson JT, Parver LM, Enger CL, Mieler WF, Liggett PE. Infectious endophthalmitis after penetrating injuries with retained intraocular foreign bodies. National Eye Trauma System. Ophthalmology 1993;100:1468-74.  Back to cited text no. 6
    
7.
Ahmed Y, Schimel AM, Pathengay A, Colyer MH, Flynn HW Jr. Endophthalmitis following open-globe injuries. Eye (Lond) 2012;26:212-7.  Back to cited text no. 7
    
8.
Chen KC, Yang CS, Hsieh MC, Tsai HY, Lee FL, Hsu WM. Successful management of double penetrating ocular trauma with retinal detachment and traumatic endophthalmitis in a child. J Chin Med Assoc 2008;71:159-62.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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