Ophthalmology Department, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu City, Sichuan Province, China.
Ophthalmology Department, The People's Hospital of Leshan, No. 238 Baita Street, Shizhong District, Central District, Leshan City, Sichuan Province, China.
BMC Ophthalmol. 2023 Mar 30;23(1):130. doi: 10.1186/s12886-023-02881-w.
Ocular trauma is complex and varied, and some occult intraocular foreign bodies (IOFBs) can lead to uncommon symptoms and signs. We report a case of rhegmatogenous retinal detachment (no obvious wound, no pain, no intraocular infection or other symptoms) caused by an occult intraocular aluminium foreign body, which could have been easily missed.
A 42-year-old male presented to the outpatient department of our hospital complaining of fluttering black dots and decreased vision in his left eye that began 3 months earlier. He was diagnosed with "floaters" at a community hospital. He denied a history of ocular trauma or previous surgery. The cornea and lens of the left eye were clear. A small patch of pigmentation was noted in the temporal sclera. Fundoscopy revealed macula-off retinal detachment. After mydriasis, elliptical holes were seen in the peripheral retina at 2:30, and a suspicious hyperreflective strip was found under the anterior lip of the retina by Goldmann three-mirror contact lens examination; the strip was confirmed to be an IOFB by orbital CT. The IOFB was removed through pars plana vitrectomy without any complications.
Unlike iron and copper IOFBs, aluminium IOFBs are more inert and more likely to be missed. For people with special occupations (construction workers, mechanics, etc.), when abnormal pigmentation of the sclera is found, the possibility of foreign bodies in the eye should be considered. In the process of disease diagnosis and treatment, it is necessary to ask for a detailed history, including occupation history and practice, and perform careful physical and targeted examinations. Such comprehensive analysis regarding the above information will minimize the chance of missed diagnosis.Awareness of occult IOFB in high risk occupations and prompt referral to a retinal surgeon is of outmost importance.
眼外伤复杂多样，一些隐匿性眼内异物（IOFB）可导致不常见的症状和体征。我们报告一例由隐匿性眼内铝异物引起的孔源性视网膜脱离（无明显伤口，无疼痛，无眼内感染或其他症状），易被漏诊。
一名 42 岁男性因左眼飘动的黑点和视力下降 3 个月到我院门诊就诊。他在社区医院被诊断为“飞蚊症”。否认眼部外伤或既往手术史。左眼的角膜和晶状体透明。颞侧巩膜可见一小片色素沉着。眼底检查发现黄斑区视网膜脱离。散瞳后，在 2：30 时发现周边视网膜有椭圆形裂孔，Goldmann 三面镜检查发现视网膜前唇下可疑高反射带；眼眶 CT 证实为 IOFB。通过经睫状体平坦部玻璃体切除术取出 IOFB，无任何并发症。
与铁和铜 IOFB 不同，铝 IOFB 更惰性，更易被漏诊。对于特殊职业人群（建筑工人、机械师等），当发现巩膜异常色素沉着时，应考虑眼内异物的可能性。在疾病诊断和治疗过程中，有必要详细询问病史，包括职业史和实践经历，并进行仔细的体格检查和有针对性的检查。综合分析上述信息可最大限度减少漏诊的机会。对于高风险职业中隐匿性 IOFB 的认识以及及时转诊至视网膜外科医生非常重要。
