Advances in ISSN: 2377-4290 AOVS

Ophthalmology & Visual System
Volume 4 Issue 4 - 2016
Imaging Considerations in Suspected Intraocular Foreign Bodies
Fortenbach CR, Rong R and Modjtahedi BS*
Eye Monitoring Center, USA
Received: July 25, 2016 | Published: July 27, 2016
*Corresponding author: Bobeck Modjtahedi, Eye Monitoring Center, Kaiser Permanente Southern California, 1011 Baldwin Park Blvd Baldwin Park, CA 91706, USA, Tel: 626 851 1011; Email:
Citation: Fortenbach CR, Rong R, Modjtahedi BS (2016) Imaging Considerations in Suspected Intraocular Foreign Bodies. Adv Ophthalmol Vis Syst 4(4): 00121. DOI: 10.15406/aovs.2016.04.00121


OGIs: Open-Globe Injuries; IOFBs: Intraocular Foreign Bodies; CT: Computed Tomography; MRI: Magnetic Resonance Imaging


Ocular trauma is a leading cause of monocular blindness in the United States [1] with more than 2.4 million eye injuries occurring annually [2]. Over 200,000 of these patients each year are found to have open-globe injuries (OGIs); [3] with between 18 and 41% being due to intraocular foreign bodies (IOFBs); [4]. Given the potentially devastating complications that can arise from IOFBs, including rates of endophthalmitis approaching 13% [5], appropriate diagnosis and treatment are critical to obtain the best visual outcome. IOFBs pose several unique challenges, including but not limited to, the difficulty associated with visualizing the foreign body, which is frequently of unknown composition. Here we briefly discuss the common materials composing IOFBs and the challenges associated with their detection.

The mechanisms of trauma resulting in IOFBs vary greatly and play a critical role in establishing the material responsible for injury. The most common place of injury is the workplace [6] and IOFBs ultimately result in 3.3% of all occupational injuries causing lost workdays [7]. Injury most commonly results from hammering (60-80% of IOFBs), but use of power tools and firearms also constitute common mechanisms of injury [4]. Penetrating foreign bodies most commonly enter through the cornea [8] with a majority being ultimately found in the posterior segment [9]. Given the common mechanisms of injury, it is unsurprising that most IOFBs are metallic in origin; however, organic materials (e.g., wood, thorns, and hair) are also common culprits and pose unique challenges in detection.

While the history and physical examination are of significant utility in the evaluation of IOFBs, they are often limited by severity and complexity of the injury. Although some advocate plain film radiographs for screening, images can fail to visualize smaller [10] and radiolucent [11] objects. Computed tomography (CT) allows for the detection of smaller foreign bodies [12] and can also aid in detection of globe rupture and thus represents the most often initial imaging test in most centers. Magnetic resonance imaging (MRI) and ultrasound hold greatest utility as adjunctive tests following CT. If the presence of a metallic IOFB can be excluded, magnetic resonance imaging can provide insights although its use is often limited by practical considerations such as availability and scanning time in the trauma setting. Ultrasound is operator dependent and risk further globe trauma in inexperienced hands.

Metallic foreign bodies can usually be easily detected on CT scan, and efforts have been made to differentiate metal type based on imaging characteristics [13]. Organic material poses significant challenges in image detection. For instance, wood can present with varying density (depending upon its type and hydration status), which can result in an appearance similar to fat or even air. This, in part, results in an inability to detect these particles on plain film x-ray [14,13] and only limited success with CT and MRI [15]. Left untreated, these foreign bodies can result in significant morbidity including cellulitis, abscess formation, orbitocutaneous fistulas, and osteomyelitis among other sequelae. The ability to differentiate types of metal holds value as this can effect prognosis (with iron and copper holding greater pathogenicity) and surgical approach (e.g., the utility of using a magnet for IOFB removal intra-operatively). CT holds the greatest ability to divide metallic IOFBs into different categories based on density and artifact produced [13], although exact determination is often challenging. Imaging characteristics of different IOFBs have been previously described [14,13,16,17] and the reader is referred to these sources for a more detailed discussion of specific findings.

The presence of an IOFB significantly changes the prognosis and management of patients with open globe injuries. Physicians should maintain a high index of suspicion for the presence of an IOFB when evaluated ocular trauma patients. Clinical exam is often limited in these settings [18] and as such imaging plays a central role in the detection and evaluation of IOFBs. Ophthalmologists should have a strong familiarity of imaging principles. Timely detection and subsequent treatment in IOFB based injuries can mitigate their significant complications and improve visual outcomes.


  1. Leonard RM (2002) Statistics on vision impairment: A resource manual: Lighthouse International.
  2. Parver LM, Dannenberg AL, Blacklow B, Fowler CJ, Brechner RJ, et al. (1993) Characteristics and causes of penetrating eye injuries reported to the National Eye Trauma System Registry, 1985-91. Public Health Rep 108(5): 625-632.
  3. Schmidt G, Broman A, Hindman HB, Grant MP (2008) Vision survival after open globe injury predicted by classification and regression tree analysis. Ophthalmology 115(1): 202-209.
  4. Loporchio D, Mukkamala L, Gorukanti K, Zarbin M, Langer P, et al. (2016) Intraocular foreign bodies: A review. Surv Ophthalmol doi: 10.1016/j.survophthal.2016.03.005.
  5. Mieler WF, Ellis MK, Williams DF, Han DP (1990) Retained Intraocular Fore ign Bodies and Endonhthalmltls. Ophthalmology 97(11): 1532-1538.
  6. Kuhn F, Morris R, Witherspoon CD, Mann L (2006) Epidemiology of blinding trauma in the United States eye injury registry. Ophthalmic Epidemiol 13(3): 209-216.
  7. Cheung CA, Rogers-Martel M, Golas L, Chepurny A, Martel JB, et al. (2014) Hospital-based ocular emergencies: epidemiology, treatment, and visual outcomes. Am J Emerg Med 32(3): 221-224.
  8. Rathod R, Mieler W (2011) An update on the management of intraocular foreign bodies. Retinal Physician.
  9. Katz G, Moisseiev J (2009) Posterior-segment intraocular foreign bodies: An update on management. Risks of infection, scarring and vision loss are among the many concerns to address. Retinal Physician, pp. 20.
  10. Otto PM, Otto RA, Virapongse C, Friedman SM, Emerson S, et al. (1992) Screening test for detection of metallic foreign objects in the orbit before magnetic resonance imaging. Invest Radiol 27(4): 308-310.
  11. Mc Elvanney AM, Fielder AR (1993) Intraocular foreign body missed by radiography. BMJ 306(6884): 1060-1061.
  12. Chacko JG, Figueroa RE, Johnson MH, Marcus DM, Brooks SE (1997) Detection and localization of steel intraocular foreign bodies using computed tomography: A comparison of helical and conventional axial scanning. Ophthalmology 104(2): 319-323.
  13. Modjtahedi BS, Rong A, Bobinski M, McGahan J, Morse LS (2015) Imaging characteristics of intraocular foreign bodies: a comparative study of plain film X-ray, computed tomography, ultrasound, and magnetic resonance imaging. Retina 35(1): 95-104.
  14. Lagalla R, Manfre L, Caronia A, Bencivinni F, Duranti C, et al. (2000) 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 Radiol 10(8): 1338-1341.
  15. Nasr AM, Haik BG, Fleming JC, Al-Hussain HM, Karcioglu ZA (1999) Penetrating orbital injury with organic foreign bodies. Ophthalmology 106(3): 523-532.
  16. Moisseiev E, Barequet D, Zunz E, Barak A, Mardor Y, et al. (2015) Validation of an Algorithm for Nonmetallic Intraocular Foreign Bodies' Composition Identification Based on Computed Tomography and Magnetic Resonance Imaging. Retina 35(9): 1898-1904.
  17. Moisseiev E, Last D, Goez D, Barak A, Mardor Y (2015) Magnetic resonance imaging and computed tomography for the detection and characterization of nonmetallic intraocular foreign bodies. Retina 35(1): 82-94.
  18. Patel SN, Langer PD, Zarbin MA, Bhagat N (2011) Diagnostic value of clinical examination and radiographic imaging in identification of intraocular foreign bodies in open globe injury. Eur J Ophthalmol 22(2): 259-268.
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