Any eye injury sustained while hammering metal on metal, chiselling or grinding should be treated as a possible intraocular foreign body, even if the entry wound is tiny or self-sealed. Visual acuity may be surprisingly good at first.
Non-contrast CT of the orbits with thin slices is the imaging of choice to detect and localise metallic fragments. MRI is contraindicated until a ferromagnetic foreign body has been excluded, because the fragment can move and cause further damage.
- Ask exactly what the patient was doing at the moment of injury; hammering or grinding raises suspicion.
- Examine carefully for a small corneal or scleral entry wound, iris hole or lens opacity.
- Request thin-slice non-contrast CT of the orbits when a metallic foreign body is possible.
- Do not request MRI until a metallic foreign body has been ruled out.
- Shield the eye, avoid pressure, and refer urgently to ophthalmology.
Why it matters
A missed metallic fragment can cause endophthalmitis or siderosis weeks later, after the chance for early surgery has passed.
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