Diagnostic value of clinical examination and radiographic imaging in identification of intraocular foreign bodies in open globe injury

Purpose. 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.