Corneal Foreign Body: The Unexpected Nightmare.

Published 2022 - 40th Congress of the ESCRS

Reference: PO279 | Type: ESCRS 2022 - Posters | DOI: 10.82333/2wxd-2r63

Authors: Victoria Segura Fernandez Nogueras* ¹ , Jose Manuel Diaz Bernal ¹ , Yolanda Fernandez Barrientos ¹

¹Ophthalmology,Hospital Universitario Virgen de la Victoria,Malaga,Spain

Purpose

30% of red eyes consulting in the Emergency Room are corneal foreign bodies. Corneal foreign body (CFB) is a mild ocular emergency whose treatment consists ofin removing the FB and prescribing topical antibiotics. Even when the management of a CFB is artless and repetitive it must be performed with caution since it has associated risks. Our aim is to report a case of a CFB-related corneal perforation and hence to remind the importance of a correct and safe technique when treating this frequent ocular emergency.

Setting

Department of Ophthalmology in a tertiary level hospital of Spain (Universitary Hospital Virgen de la Victoria in Malaga, Spain).

Methods

A case report. We present a 53 years old Caucasic man, with a history of central CFB removal two months before, who attended the Emergency Room (ER) complaining about acute pain and redness in his left eye (LE).

The anterior segment examination revealed the presence of a foreign body and a thick old iron rust located in the nasal corneal limbus and in the central cornea respectively. The first one was removed with a blunt fill needle as usual. The second one was deeper and surrounded by weak corneal stroma, and when removing it an aqueous humor leakage was detected without affecting anterior chamber depth.

Results

First approach of the corneal microperforation was a bandage contact lens and combined topical antibiotics, however the first day of follow up the eye was in athalamia. The second treatment performed was corneal reparation with cyanoacrylate, but the anterior chamber did not reform. Finally, the patient was proposed for an urgent amniotic membrane transplant (AMT) which was effective treating the microperforation.

A month after the AMT the patient consulted again in the ER complaining of intense pain and an endophthalmitis was detected. The infection was treated with intravitreal vancomycin and ceftazidime, oral moxifloxacin and topical vancomycin and ceftazidime.

Two months after it the patient reached a complete recovery.

Conclusions

CFB is one of the most common ocular emergencies worldwide. Its well-known management includes removing the foreign body and the whole iron rust ring since leaving it may lead to a severe stromal damage. This unfortunate case shows that even the easiest condition can get complicated and so encourages us as ophthalmologists to be delicate and accurate in every single procedure we perform.