A SHIMMER IN THE SHADOWS: THE CASE OF HIDDEN GIANT CRESCENT INTRAOCULAR FOREIGN BODY

Abstract

Ocular Trauma with Intraocular Foreign Body (IOFB) is a serious ophthalmic emergency that needs urgent treatment. Prompt intervention and antimicrobial strategies are critical to prevent endophthalmitis and poor visual outcomes. A 29-year-old male presented with pain in his right eye (RE) after being struck by a metal fragment 12 hours prior to admission. Examination revealed a full-thickness laceration of the superior palpebra of the RE, accompanied by scleral laceration beneath it. The head CT scan and ocular ultrasound confirmed the presence of IOFB penetrating the RE. In the Emergency Room (ER), he underwent scleral-palpebral suturing and intravitreal antibiotic injection. Due to limited surgical equipment and the absence of a vitreoretinal surgeon in the ER, vitrectomy surgery was delayed. One week later, he was performed IOFB extraction and vitrectomy with Sulfur hexafluoride (SF6) gas tamponade. During the procedure, a large metallic IOFB was discovered beneath the subretinal space in the macular area. Additional findings included vitreous hemorrhage and retinal detachment in the superior and inferotemporal regions. The IOFB was successfully removed, though with limited visual prognosis. However, no signs of intraocular infection were observed. In IOFB cases, immediate globe closure and antimicrobial prophylaxis are crucial to prevent infection. When simultaneous IOFB removal and globe closure are not feasible, prioritizing globe closure and employing aggressive antibiotic prophylaxis is an alternative to prevent endophthalmitis.