Removal of an intraorbital metallic foreign body following double-penetrating ocular injury

Rationale: Open eye injury is one of the commonest ophthalmic emergencies, and when accompanied by intraorbital foreign bodies, the condition carries a poor prognosis. Patient concerns: A 28-year-old man presented to the emergency department of our hospital complaining of sudden painful loss of vision in the left eye after he hammered an iron plate. Diagnosis: The ocular examination revealed a 4-mm full thickness scleral laceration with prolapsed uveal tissue, a traumatic cataract. Computed tomography (CT) demonstrated an orbital foreign body in the retrobulbar area. Interventions: The patient underwent emergency scleral suturing, severance of medial rectus muscle, and removal of the orbital foreign body. Twelve days after the emergency operation, pars plana lensectomy and pars plana vitrectomy were performed. Outcomes: After 3 months of follow-up, there was no immune response. Visual acuity in the left eye was the perception of hand motion. The retina remained mostly attached with normal intraocular pressure, and good cosmetic appearance. The globe anatomy was maintained, but the vision could not be restored due to the grave nature of the trauma. Lessons: Transconjunctival approach extraocular muscle severance may thus be a suitable approach to the removal of intraorbital metallic foreign body.