Shitole Satish C, Barot Rakesh K, Shah Rakesh, Bhagat Nupur
Assistant Professor, Department of Ophthalmology, Rajiv Gandhi Medical College and CSM Hospital , Kalwa, Thane, Maharashtra, India .
Associate Professor, Department of Ophthalmology, Rajiv Gandhi Medical College and CSM Hospital , Kalwa, Thane, Maharashtra, India .
J Clin Diagn Res. 2016 Apr;10(4):ND08-10. doi: 10.7860/JCDR/2016/17851.7606. Epub 2016 Apr 1.
Ocular injury secondary to foreign body remains an important cause of ocular morbidity with or without blindness in working population. Intraocular foreign body may have varied clinical presentation. Initially it may look an apparently normal eye followed by obvious ocular symptoms depending upon its location and degree of inflammation. It can result in partial or full thickness penetration of sclera with or without involvement of posterior segment. We hereby present two cases of metallic intrascleral foreign body entry through upper lid in young carpenters following hammer and chisel injury. In case 1, Intrascleral location of foreign body was confirmed with X ray orbit and B scan ultrasonography while in case 2 the diagnosis of intrascleral foreign body was missed at the first visit to ophthalmology clinic Both the patients underwent exploratory surgeries where intrascleral metallic foreign bodies were found without ocular penetration. An intrascleral foreign body may be missed due to small penetrating scleral wound covered by a large subconjunctival haemorrhage accompanied by minimal or no signs of inflammation and failure on part of treating ophthalmologist to suspect an intrascleral foreign body. To establish a diagnosis of intraocular particularly intrascleral foreign body, careful history taking and clinical examination along with use of imaging studies are mandatory steps which help in successful management and good visual outcome. These cases highlight the importance of considering a presumptive diagnosis of retained intrascleral foreign body in every patient with a history of penetrating ocular trauma through lid or a visible wound/scar on the lid.
在劳动人口中，异物导致的眼外伤仍然是导致眼部发病（无论是否致盲）的一个重要原因。眼内异物可能有多种临床表现。最初，它可能看似是一只外观正常的眼睛，随后根据其位置和炎症程度出现明显的眼部症状。它可导致巩膜部分或全层穿透，伴或不伴有眼后段受累。我们在此报告两例年轻木匠在锤子和凿子受伤后，金属巩膜内异物经上睑进入的病例。在病例1中，通过眼眶X线和B超检查确认了异物的巩膜内位置，而在病例2中，在首次眼科门诊就诊时漏诊了巩膜内异物。两名患者均接受了探查手术，术中发现巩膜内金属异物，未穿透眼球。巩膜内异物可能因小的巩膜穿透伤口被大片结膜下出血覆盖，伴有轻微或无炎症迹象，以及治疗眼科医生未能怀疑巩膜内异物而被漏诊。为了确诊眼内尤其是巩膜内异物，仔细的病史采集、临床检查以及影像学检查的应用是必要步骤，有助于成功治疗并获得良好的视力预后。这些病例凸显了对于每一位有眼睑穿透性眼外伤病史或眼睑可见伤口/瘢痕的患者，考虑巩膜内异物存留的推定诊断的重要性。
