Fig. 12. Endophthalmitis. Transverse B-scan shows marked vitreous opacities and membrane formation consistent with endophthalmitis.

sutures, air bubbles, and retained lens fragments can closely resemble true IOFBs, frequently presenting as small points of highly reflective echoes with a combination of reverberation echoes and shadowing present.2,39

Management of trauma with retained IOFBs involves surgical removal of the foreign body, most commonly performed using vitrectomy techniques. Early removal of the foreign body (ie, within 24 hours of injury) seems to be one of the variables associated with better visual outcome in such cases. IOFB size and composition, presenting visual acuity, and the extent of associated ocular injuries also seem to be important indicators of subsequent course and visual prognosis.40–43 In general, it is preferable to remove IOFBs early so as to minimize the risk of endophthalmitis, although delayed intervention may achieve a good outcome in some settings.44

ENDOPHTHALMITIS

Endophthalmitis can occur in the setting of openglobe injury. Reported rates vary from 0% to 16.5%, but the average incidence of endophthalmitis in open-globe trauma is likely around 7%.45–49 According to the United States Eye Injury Registry database, out of 10,309 serious ocular trauma cases, 39% presented with an open globe, and of these, 3.4% developed endophthalmitis.50 Retained foreign body composed of vegetative material, delayed repair (> 24 hours), lens capsule disruption, and the presence of a contaminated wound are important risk factors for development of endophthalmitis.50–52

Although endophthalmitis is diagnosed clinically based on such signs as conjunctival injection and chemosis, anterior chamber fibrin, hypopion, and vitritis, ultrasonography can aid in the examination

of an often poorly visible posterior segment. B-scan ultrasound of an affected eye typically reveals dense vitreous opacities and moderate to marked, irregular, web-like vitreous membrane formation (Fig. 12).

REFERENCES

1.Pieramici DJ. Vitreoretinal trauma. Ophthalmol Clin North Am 2002;15:225–34, vii.

2.McNicholas MM, Brophy DP, Power WJ, et al. Ocular trauma: evaluation with US. Radiology 1995;195: 423–7.

3.Rubsamen PE, Cousins SW, Winward KE, et al. Diagnostic ultrasound and pars plana vitrectomy in penetrating ocular trauma. Ophthalmology 1994; 101:809–14.

4.Scott IU, Smiddy WE, Feuer WJ, et al. The impact of echography on evaluation and management of posterior segment disorders. Am J Ophthalmol 2004;137:24–9.

5.Haimann MH, Burton TC, Brown CK. Epidemiology of retinal detachment. Arch Ophthalmol 1982;100: 289–92.

6.Sarrafizadeh R, Hassan TS, Ruby AJ, et al. Incidence of retinal detachment and visual outcome in eyes presenting with posterior vitreous separation and dense fundus-obscuring vitreous hemorrhage. Ophthalmology 2001;108:2273–8.

7.Rabinowitz R, Yagev R, Shoham A, et al. Comparison between clinical and ultrasound findings in patients with vitreous hemorrhage. Eye 2004;18:253–6.

8.Kennedy CJ, Parker CE, McAllister IL. Retinal detachment caused by retinal dialysis. Aust N Z J Ophthalmol 1997;25:25–30.

9.Nacef L, Daghfous F, Chaabini M, et al. [Ocular contusions and giant retinal tears]. J Fr Ophtalmol 1997;20:170–4 [in French].

10.Johnston S. Perforating eye injuries: a five year survey. Trans Ophthalmol Soc U K 1971;91:895–921.

11.Cleary PE, Ryan SJ. Histology of wound, vitreous, and retina in experimental posterior penetrating eye injury in the rhesus monkey. Am J Ophthalmol 1979;88:221–31.

12.Cleary PE, Ryan SJ. Method of production and natural history of experimental posterior penetrating eye injury in the rhesus monkey. Am J Ophthalmol 1979;88:212–20.

13.Kelley LM, Walker JP, Wing GL, et al. Ultrasoundguided cryotherapy for retinal tears in patients with vitreous hemorrhage. Ophthalmic Surg Lasers 1997;28:565–9.

14.Liggett PE, Mani N, Green RE, et al. Management of traumatic rupture of the globe in aphakic patients. Retina 1990;10(Suppl 1):S59–64.

15.Chu TG, Cano MR, Green RL, et al. Massive suprachoroidal hemorrhage with central retinal

apposition: a clinical and echographic study. Arch Ophthalmol 1991;109:1575–81.

16.Izadi S, Stewart RM, Jain S. Bilateral posterior dislocation of the crystalline lens after a head injury sustained during a seizure. Emerg Med J 2007;24:e6.

17.Blackmon SM, Fekrat S, Setlik DE, et al. Posterior dislocation of a crystalline lens associated with airbag deployment. J Cataract Refract Surg 2005; 31:2431–2.

18.Farr AK, Fekrat S. Eye injuries associated with paintball guns. Int Ophthalmol 1998;22:169–73.

19.Thach AB, Ward TP, Hollifield RD, et al. Ocular injuries from paintball pellets. Ophthalmology 1999; 106:533–7.

20.Cavallini GM, Lugli N, Campi L, et al. Bottle-cork injury to the eye: a review of 13 cases. Eur J Ophthalmol 2003;13:287–91.

21.Chorich LJ 3rd, Davidorf FH, Chambers RB, et al.

Bungee cord-associated ocular injuries. Am J Ophthalmol 1998;125:270–2.

22.Cooney MJ, Pieramici DJ. Eye injuries caused by bungee cords. Ophthalmology 1997;104:1644–7.

23.Nichols CJ, Boldt HC, Mieler WF, et al. Ocular injuries caused by elastic cords. Arch Ophthalmol 1991;109:371–2.

24.Gaur A, Sharma YR, Sudan R. Subconjunctival lens dislocation. J Cataract Refract Surg 2005;31:13–4.

25.Sathish S, Chakrabarti A, Prajna V. Traumatic subconjunctival dislocation of the crystalline lens and its surgical management. Ophthalmic Surg Lasers 1999;30:684–6.

26.Yurdakul NS, Ugurlu S, Yilmaz A, et al. Traumatic subconjunctival crystalline lens dislocation. J Cataract Refract Surg 2003;29:2407–10.

27.Greven CM, Collins AS, Slusher MM, et al. Visual results, prognostic indicators, and posterior segment findings following surgery for cataract/lens subluxa- tion-dislocation secondary to ocular contusion injuries. Retina 2002;22:575–80.

28.Mester V, Kuhn F. Intraocular foreign bodies. Ophthalmol Clin North Am 2002;15:235–42.

29.Percival SP. A decade of intraocular foreign bodies. Br J Ophthalmol 1972;56:454–61.

30.Roper-Hall MJ. Review of 555 cases of intra-ocular foreign body with special reference to prognosis. Br J Ophthalmol 1954;38:65–99.

31.Williams DF, Mieler WF, Abrams GW, et al. Results and prognostic factors in penetrating ocular injuries with retained intraocular foreign bodies. Ophthalmology 1988;95:911–6.

32.Kuhn F, Halda T, Witherspoon CD, et al. Intraocular foreign bodies: myths and truths. Eur J Ophthalmol 1996;6:464–71.

33.Weiss MJ, Hofeldt AJ, Behrens M, et al. Ocular siderosis: diagnosis and management. Retina 1997;17:105–8.

34.Bettman JW. Seven hundred medicolegal cases in ophthalmology. Ophthalmology 1990;97:1379–84.

35.Chacko JG, Figueroa RE, Johnson MH, et al. Detection and localization of steel intraocular foreign bodies using computed tomography: a comparison of helical and conventional axial scanning. Ophthalmology 1997;104:319–23.

36.Wu JT, Lam DS, Fan DS, et al. Intravitreal phaco chopper fragment missed by computed tomography. Br J Ophthalmol 1998;82:460–1.

37.Bryden FM, Pyott AA, Bailey M, et al. Real time ultrasound in the assessment of intraocular foreign bodies. Eye 1990;4(Pt 5):727–31.

38.Shiver SA, Lyon M, Blaivas M. Detection of metallic ocular foreign bodies with handheld sonography in a porcine model. J Ultrasound Med 2005;24:1341–6.

39.Bhavsar AR, Fong DS, Kerman B, et al. Intraorbital air simulating an intraocular foreign body. Am J Ophthalmol 1997;123:835–7.

40.Jonas JB, Knorr HL, Budde WM. Prognostic factors in ocular injuries caused by intraocular or retrobulbar foreign bodies. Ophthalmology 2000;107:823–8.

41.Chaudhry IA, Shamsi FA, Al-Harthi E, et al. Incidence and visual outcome of endophthalmitis associated with intraocular foreign bodies. Graefes Arch Clin Exp Ophthalmol 2008;246:181–6.

42.Szijarto Z, Gaal V, Kovacs B, et al. Prognosis of penetrating eye injuries with posterior segment intraocular foreign body. Graefes Arch Clin Exp Ophthalmol 2008;246:161–5.

43.Chiquet C, Zech JC, Gain P, et al. Visual outcome and prognostic factors after magnetic extraction of posterior segment foreign bodies in 40 cases. Br J Ophthalmol 1998;82:801–6.

44.Colyer MH, Weber ED, Weichel ED, et al. Delayed intraocular foreign body removal without endophthalmitis during operations Iraqi freedom and enduring freedom. Ophthalmology 2007;114:1439–47.

45.Affeldt JC, Flynn HW Jr, Forster RK, et al. Microbial endophthalmitis resulting from ocular trauma. Ophthalmology 1987;94:407–13.

46.Brinton GS, Topping TM, Hyndiuk RA, et al. Posttraumatic endophthalmitis. Arch Ophthalmol 1984;102: 547–50.

47.Essex RW, Yi Q, Charles PG, et al. Post-traumatic endophthalmitis. Ophthalmology 2004;111:2015–22.

48.Thompson WS, Rubsamen PE, Flynn HW Jr, et al. Endophthalmitis after penetrating trauma: risk factors and visual acuity outcomes. Ophthalmology 1995;102:1696–701.

49.Verbraeken H, Rysselaere M. Post-traumatic endophthalmitis. Eur J Ophthalmol 1994;4:1–5.

50.Danis RP. Endophthalmitis. Ophthalmol Clin North Am 2002;15:243–8.

51.Boldt HC, Pulido JS, Blodi CF, et al. Rural endophthalmitis. Ophthalmology 1989;96:1722–6.

52.Lemley CA, Han DP. Endophthalmitis: a review of current evaluation and management. Retina 2007; 27:662–80.