Chisel-and-hammer foreign bodies: vitrectomy restored the anatomy in most, and delay mattered

Design

Retrospective case series, single Indian tertiary centre, 5 years

Population

29 patients with posterior segment metallic foreign bodies after chisel-hammer injury

Primary outcome

Anatomical success and best-corrected visual acuity

Effect

Anatomical success 89.6%; logMAR 2.4 → 1.2 (P < 0.001)

A tertiary centre in India reviewed 29 patients, almost all young men, who had vitrectomy for metallic intraocular foreign bodies in the posterior segment after chisel-and-hammer injuries over five years.

At presentation, most had traumatic cataract and vitreous haemorrhage; seven had retinal detachment, six endophthalmitis and two siderosis. The foreign body was removed in all but four, where it lay too deep, and the lens had to be removed in over 80%. Anatomical success was achieved in about 90%, and mean vision improved from logMAR 2.4 to 1.2.

A longer interval between primary repair and vitrectomy, poorer initial vision, vitreous haemorrhage and postoperative macular pucker were linked to worse final vision. The series is small and retrospective, but it reflects a common occupational injury in India and supports early referral for vitrectomy and careful imaging to locate deep foreign bodies.

• Suspect a retained foreign body in any eye injury involving hammering metal on metal or stone, even with a small entry wound.
• Refer early to a vitreoretinal service; a longer interval before vitrectomy was linked to worse vision.
• Use CT to locate the foreign body and plan surgery, especially for posterior or deep fragments.
• Watch for endophthalmitis, retinal detachment and siderosis, all seen at presentation in this series.
• Advise protective eyewear for workers using chisels and hammers.

Why it matters

This occupational injury mostly affects young working men, and timing of surgery appears to shape how much sight they keep.

Don't overread it

A small retrospective series cannot define the optimal timing of vitrectomy; it shows an association with delay.

The statistics, in plain English

logMAR 2.4 is roughly hand-movements vision; logMAR 1.2 is about 6/96 (20/320). The improvement is large but many patients still had poor vision.

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