Toy Story

Author: Rosa Pinheiro (Portugal)

Co-authors: Filipe Henriques, Joaquim Murta

Purpose

To describe the outcomes of traumatic endophthalmitis in a child due to metallic intraocular foreign body.

Setting/Venue

Department of Ophthalmology at the University Hospital of Coimbra.

Methods

A 6-year-old boy came to the emergency department with a painful red eye after playing with a hoe dag on the previous day. Visual acuity (VA) was 20/20 in the right eye and hand motions in the left eye (LE). On slit lamp evaluation of the LE, there was corneal haze, a small full-thickness corneal wound Seidel-negative, cell and flare 3+ and pupillary fibrinous membrane. Slit lamp examination of the right eye was unremarkable. A CT scan of the orbits confirmed the suspicion of an intraocular metallic foreign body and the parents agreed to surgery.

Results

The child was submitted to immediate vitreoretinal surgery. Inflammatory membranes were removed from the anterior chamber and the corneal wound was sutured. A 23-gauge pars plana vitrectomy was performed along with posterior vitreous detachment; focal retinal necrosis, frosted-branch angiitis and macular hypopyon were noted at this point. Then, a lensectomy was performed, with caution not to damage the anterior capsule. The foreign body was removed via pars plana using a bimanual technique with an internal eletromagnet and membrane forceps, and 360º endolaser was applied. An inferior iridectomy was performed. Finally, after fluid-air exchange, the vitreous cavity was filled with silicone oil. Intravenous and intravitreal antibiotics were administered. A few weeks postoperatively, the VA on the LE remained hand motions and the anterior chamber was quiet. Four months later, the child underwent reoperation. There was complete anterior capsular fibrosis, and capsulotomy was achieved with retinal scissors. Silicone oil was removed, and retina status was assessed. Then, a 3-piece lens was inserted followed by optic capture. Two months later, VA of the LE was 20/200 and the child keeps following amblyopia treatment.

Conlusions

This video shows the management of endophthalmitis due to a metallic intraocular foreign body in a 6-year-old child. Traumatic endophthalmitis is usually aggressive in nature and can jeopardize sight and globe integrity. An immediate surgical approach was crucial to prevent catastrophic consequences. Functional results in pediatric age are also dependent on post-surgical amblyopia treatment.

Financial Disclosure

No financial interests to disclose