Metallic foreign bodies tend to enter the eyes of those who operate high-speed grinders without goggles or those using a hammer and chisel on metal without eye protection. These injuries might seem slight at first and sometimes patients do not attach much importance to them. Any such eye injury with this occupational history warrants an X-ray of the eye. When ferrous metals remain in the eye they can cause immediate infection, or at a later date the deposition of ferrous salts, in a process known as siderosis. This can eventually lead to blindness of the eye. Other metals also tend to give reactions, particularly copper and for this reason the metallic fragment should be removed (Figure 16.4). This is achieved either by using intravit-
reous forceps under microscopic control or using a magnet. The exact surgical technique is planned beforehand once the foreign body has been accurately localised in the eye. Airgun pellets cause particularly severe eye injuries and the eye is often lost because of the extensive disruption at the time of the injury. Some intraocular foreign bodies, such as glass particles or some alloys, might be tolerated quite well and a decision could have to be made as to whether observation is preferable in the first instance. This especially applies when the sight of the eye remains good. When a foreign body is not to be removed immediately, many ophthalmologists would insert intravitreal antibiotics as a prophylactic measure against endophthalmitis. When a foreign body is found lying deeply in the cornea, its removal can result in loss of aqueous and collapse of the anterior chamber. It is prudent to arrange that removal should be done under full sterile conditions in the operating theatre, where the corneal wound can be sutured if necessary.
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