Intraocular Foreign Body and Uveitis


History of Present Illness

CC: I think something is in my left eye!” A backyard gate was closed with a chain and lock. The combination to the lock was lost, and so a 54-year-old man used a hammer and chisel in an attempt to break a link in the chain. After hitting the steel chisel with a hammer, he felt a sharp pain in the left eye (OS). His vision was still fairly good, and the sharp pain subsided, so he decided to wait until the next day before seeing a doctor. On awakening, he had mild discomfort OS and noticed sensitivity to light.

Exam
OD OS
Visual acuity 20/25 20/40
Intraocular pressure (IOP) 14 12
Sclera/conjunctiva Clear. No injection. Focal conjunctival injection and a small (2 mm) laceration at 9:00 near the corneal limbus.
Cornea WNL Clear without laceration. Few fine nongranulomatous keratic precipitate (KP) inferiorly.
Anterior chamber (AC) No flare or cell. 1+ flare and 1+ cells
Iris WNL Pupil small but reactive to light and without an APD.
Lens 1+ NS 1+ NS
Vitreous cavity Clear without vitreous cells 1+ vitreous cells
Retina/optic nerve WNL IOFB, ≈2 mm in diameter, lying on retinal surface just below optic disc with adjacent hemorrhage (see Fig. 25.1 )

Fig. 25.1, IOFB lying on retinal surface, inferior to optic disc, OS.

Questions to Ask

  • Were you wearing glasses or protective lenses at the time of the injury?

  • What was your vision like in both eyes (OU) before the accident?

  • Have you had any previous eye surgery?

  • Did you put any drops or ointment in your eye before visiting us?

  • When was the last time you had something to eat and/or drink?

  • Are you allergic to any antibiotics? Do you have other allergies?

He only wears glasses to read small print and was not wearing any protective lenses at the time of the accident. His visual acuity (VA) before the injury was 20/25 OU, and he had no history of previous eye surgery. No drops or ointment were placed in his OS before the visit. He had breakfast at 8:00 am , 8 hours ago. He is allergic to latex, but has no allergies to antibiotics.

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