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Ophthalmic Images
December 8, 2016

Metallic Foreign Body Trapped Within the Retrobulbar Part of the Optic Nerve

Author Affiliations
  • 1Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  • 2Department of Otorhinolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
JAMA Ophthalmol. 2016;134(12):e164644. doi:10.1001/jamaophthalmol.2016.4644

A man in his 20s presented with decreased visual acuity of 20/400 OD for 1 month. He said something had struck the eye while using a hammer and chisel. Right eye examination revealed an entry wound between the limbus and medial rectus as well as an exit wound nasal to the optic disc (Figure, A). Noncontrast computed tomographic scan revealed a foreign body trapped within the retrobulbar portion of the right optic nerve (Figure, B). Laser photocoagulation of the retina was done around the exit site to prevent retinal detachment. An intraoptic nerve foreign body is extremely rare.1,2 Surgical intervention was deferred in this case because of its localization within the optic nerve and a self-sealed anterior laceration.3,4 One month later, visual acuity was 2/60 OD (approximate Snellen equivalent 20/600) and the retina was attached. The patient was counseled about the major long-term risks such as retinal detachment and optic atrophy.

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