CONTACT LENS INTRAOCULAR FOREIGN BODY PRESENTING 1 YEAR AFTER TRAUMATIC OPEN GLOBE REPAIR Scott M. Warden, MD, Sophia I. Pachydaki, MD, Tania Paul, MD, Donald J. D’Amico, MD
Purpose: To describe an intraocular contact lens presenting as a foreign body 1 year after repair of a traumatic open globe. Method: A case report. Results: The patient underwent open globe repair for a scleral laceration. The patient’s vision returned to 20/20 and had no ocular complaints until 1 year later when he had a large floater. Examination revealed an intraocular contact lens in the anterior vitreous that was successfully removed by pars plana vitrectomy. The patient’s vision returned to 20/20 with resolution of his floater. Conclusion: Ophthalmologists should be aware that a contact lens can gain access to the posterior segment in the setting of trauma. These intraocular foreign bodies can remain asymptomatic and undiagnosed for an extensive period of time until they gradually migrate into the visual axis. RETINAL CASES & BRIEF REPORTS 3:429 – 430, 2009
From the Weill Cornell Department of Ophthalmology, Retina Service, New York-Presbyterian Hospital, New York, New York.
unremarkable. No relative afferent pupillary defect was seen. There was a 0.5-mm hyphema. A 3-mm linear full-thickness scleral laceration was found 2.5 mm from the temporal limbus. The lens and iris were normal. Dilated fundoscopic examination revealed mild vitreous hemorrhage temporally and inferiorly. There was no retinal tear or detachment. A computed tomography scan revealed a decrease in volume of the left eye consistent with a ruptured globe, and no intraocular foreign object was seen. Due to the ruptured globe, ultrasonography was not performed to avoid mechanical pressure on the eye. The patient was brought to the operating room for surgical repair. The sclera was carefully inspected under the operating microscope, and no additional wounds were found. No ocular contents or vitreous strands emanated from the wound. The scleral laceration was closed with interrupted nylon sutures. Two weeks postoperatively, the patient’s vision returned to 20/20. Six weeks postoperatively, the vitreous hemorrhage had fully resolved, and dilated fundus examination was unremarkable. One year after the surgical repair, the patient noted an enlarging and bothersome floater in the left eye. Visual acuity was 20/20. Dilated fundoscopic examination revealed a triangular-shaped clear foreign body freely floating in the anterior vitreous (Figure 1). There was no ocular inflammation. The patient requested surgical removal of the foreign body due to significant visual frustration from the floater. Pars plana vitrectomy was performed, and the foreign body was removed through the superotemporal sclerotomy without complication (Figure 2). Under the operating microscope, the foreign body was confirmed to be a fragment of a soft contact
I
t is well recognized that “missing” contact lenses are often found folded in the upper or lower fornices. Contact lenses have also been reported to migrate into periocular tissue and result in the formation of eyelid masses. We describe a case where a contact lens was found in the vitreous of a patient 1 year after open globe repair for a traumatic scleral laceration. Case Report
A 39-year-old man presented to the emergency room after pain and loss of vision in the left eye while hammering a piece of metal at a construction site. He was not wearing safety glasses. The patient reported wearing contact lenses before the incident, although the left contact lens was missing afterward. Examination revealed visual acuity of 20/80 in the left eye. The fornices were inspected and were None of the above authors have any financial interests to disclose. Reprint requests: Donald J. D’Amico, MD, Weill Cornell Department of Ophthalmology, 1305 York Avenue, 11th Floor, New York, NY 10021; e-mail: [email protected]
429
RETINAL CASES & BRIEF REPORTSℜ
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2009
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NUMBER 4
Fig. 3. Intraoperative photograph of foreign body placed on the corneal surface after successful removal.
Fig. 1. Anterior segment photograph of patient presenting with large floater 1 year after surgical repair of ruptured globe. A clear triangularshaped foreign body is seen suspended in the anterior vitreous.
lens (Figure 3). The pathology report described the foreign body as “plastic material.” The patient’s floater immediately resolved postoperatively, and after 1 month his vision returned to 20/20.
Discussion “Missing” contact lenses are often found hidden deep in the conjuctival fornices. Rarely, they may migrate into the periocular tissue and present as an eyelid mass.1 To our knowledge, there is only one previous report of a contact lens presenting as an intraocular foreign body.2 In that report, a contact lens was found on ultrasound in the early postoperative period after repair of a full-thickness corneal laceration from a piece of wire. Visual acuity was hand motions with vitreous hemorrhage. The contact lens was removed by pars plana vitrectomy, although visual acuity remained at hand motions due to extensive retinal scarring.
Our patient presented with an intraocular contact lens fragment 1 year after repair of a traumatic scleral laceration. We propose that the contact lens fragment migrated into the anterior vitreous base, where it remained asymptomatic and undetectable on dilated funduscopic examination. After ⬃1 year, the contact lens fragment dislodged from the vitreous base and became mobile in the vitreous cavity. A limitation of our report is that the patient did not have a postoperative ultrasound after repair of the scleral laceration. Unlike the reported case above, however, our patient had excellent vision early in the postoperative period, and dilated fundoscopic examination was not limited by extensive vitreous hemorrhage. This case emphasizes that a second surgery would not necessarily be indicated even if the contact lens had been detected on ultrasound. The contact lens was well tolerated in the eye, and only when the patient developed significant symptoms was surgery considered. Ophthalmologists should be aware that a contact lens can enter the eye in the setting of an open globe injury. Thorough evaluations should be performed before and after primary surgical repair. Particularly in cases where contact lens foreign bodies are suspected, ultrasound should be performed even in the setting of a reassuring postoperative dilated fundus examination. This case also demonstrates that a soft contact lens can remain asymptomatic and well tolerated in an eye for at least 1 year. Key words: contact lens, intraocular foreign body, ruptured globe. References 1.
Fig. 2. Intraoperative photograph of pars plana vitrectomy surgery showing forceps capture of the intraocular foreign body before removal.
2.
Hayasaka Y, Hayasaka S, Nagaki Y, Endo Y. An eyelid mass caused by a migrated hard contact lens. Eye Contact Lens 2003;29:250–251. Scotcher S, Canning C, Nevill-Lamb R. ‘Lost’ contact lens presenting as an intraocular foreign body. Br J Ophthalmol 1995;79:97–98.
Purpose: To describe an intraocular contact lens presenting as a foreign body 1 year after repair of a traumatic open globe. Method: A case report. Results: The patient underwent open globe repair for a scleral laceration. The patient’s vision returned to 20/20 and had no ocular complaints until 1 year later when he had a large floater. Examination revealed an intraocular contact lens in the anterior vitreous that was successfully removed by pars plana vitrectomy. The patient’s vision returned to 20/20 with resolution of his floater. Conclusion: Ophthalmologists should be aware that a contact lens can gain access to the posterior segment in the setting of trauma. These intraocular foreign bodies can remain asymptomatic and undiagnosed for an extensive period of time until they gradually migrate into the visual axis. RETINAL CASES & BRIEF REPORTS 3:429 – 430, 2009
From the Weill Cornell Department of Ophthalmology, Retina Service, New York-Presbyterian Hospital, New York, New York.
unremarkable. No relative afferent pupillary defect was seen. There was a 0.5-mm hyphema. A 3-mm linear full-thickness scleral laceration was found 2.5 mm from the temporal limbus. The lens and iris were normal. Dilated fundoscopic examination revealed mild vitreous hemorrhage temporally and inferiorly. There was no retinal tear or detachment. A computed tomography scan revealed a decrease in volume of the left eye consistent with a ruptured globe, and no intraocular foreign object was seen. Due to the ruptured globe, ultrasonography was not performed to avoid mechanical pressure on the eye. The patient was brought to the operating room for surgical repair. The sclera was carefully inspected under the operating microscope, and no additional wounds were found. No ocular contents or vitreous strands emanated from the wound. The scleral laceration was closed with interrupted nylon sutures. Two weeks postoperatively, the patient’s vision returned to 20/20. Six weeks postoperatively, the vitreous hemorrhage had fully resolved, and dilated fundus examination was unremarkable. One year after the surgical repair, the patient noted an enlarging and bothersome floater in the left eye. Visual acuity was 20/20. Dilated fundoscopic examination revealed a triangular-shaped clear foreign body freely floating in the anterior vitreous (Figure 1). There was no ocular inflammation. The patient requested surgical removal of the foreign body due to significant visual frustration from the floater. Pars plana vitrectomy was performed, and the foreign body was removed through the superotemporal sclerotomy without complication (Figure 2). Under the operating microscope, the foreign body was confirmed to be a fragment of a soft contact
I
t is well recognized that “missing” contact lenses are often found folded in the upper or lower fornices. Contact lenses have also been reported to migrate into periocular tissue and result in the formation of eyelid masses. We describe a case where a contact lens was found in the vitreous of a patient 1 year after open globe repair for a traumatic scleral laceration. Case Report
A 39-year-old man presented to the emergency room after pain and loss of vision in the left eye while hammering a piece of metal at a construction site. He was not wearing safety glasses. The patient reported wearing contact lenses before the incident, although the left contact lens was missing afterward. Examination revealed visual acuity of 20/80 in the left eye. The fornices were inspected and were None of the above authors have any financial interests to disclose. Reprint requests: Donald J. D’Amico, MD, Weill Cornell Department of Ophthalmology, 1305 York Avenue, 11th Floor, New York, NY 10021; e-mail: [email protected]
429
RETINAL CASES & BRIEF REPORTSℜ
430
●
2009
●
VOLUME 3
●
NUMBER 4
Fig. 3. Intraoperative photograph of foreign body placed on the corneal surface after successful removal.
Fig. 1. Anterior segment photograph of patient presenting with large floater 1 year after surgical repair of ruptured globe. A clear triangularshaped foreign body is seen suspended in the anterior vitreous.
lens (Figure 3). The pathology report described the foreign body as “plastic material.” The patient’s floater immediately resolved postoperatively, and after 1 month his vision returned to 20/20.
Discussion “Missing” contact lenses are often found hidden deep in the conjuctival fornices. Rarely, they may migrate into the periocular tissue and present as an eyelid mass.1 To our knowledge, there is only one previous report of a contact lens presenting as an intraocular foreign body.2 In that report, a contact lens was found on ultrasound in the early postoperative period after repair of a full-thickness corneal laceration from a piece of wire. Visual acuity was hand motions with vitreous hemorrhage. The contact lens was removed by pars plana vitrectomy, although visual acuity remained at hand motions due to extensive retinal scarring.
Our patient presented with an intraocular contact lens fragment 1 year after repair of a traumatic scleral laceration. We propose that the contact lens fragment migrated into the anterior vitreous base, where it remained asymptomatic and undetectable on dilated funduscopic examination. After ⬃1 year, the contact lens fragment dislodged from the vitreous base and became mobile in the vitreous cavity. A limitation of our report is that the patient did not have a postoperative ultrasound after repair of the scleral laceration. Unlike the reported case above, however, our patient had excellent vision early in the postoperative period, and dilated fundoscopic examination was not limited by extensive vitreous hemorrhage. This case emphasizes that a second surgery would not necessarily be indicated even if the contact lens had been detected on ultrasound. The contact lens was well tolerated in the eye, and only when the patient developed significant symptoms was surgery considered. Ophthalmologists should be aware that a contact lens can enter the eye in the setting of an open globe injury. Thorough evaluations should be performed before and after primary surgical repair. Particularly in cases where contact lens foreign bodies are suspected, ultrasound should be performed even in the setting of a reassuring postoperative dilated fundus examination. This case also demonstrates that a soft contact lens can remain asymptomatic and well tolerated in an eye for at least 1 year. Key words: contact lens, intraocular foreign body, ruptured globe. References 1.
Fig. 2. Intraoperative photograph of pars plana vitrectomy surgery showing forceps capture of the intraocular foreign body before removal.
2.
Hayasaka Y, Hayasaka S, Nagaki Y, Endo Y. An eyelid mass caused by a migrated hard contact lens. Eye Contact Lens 2003;29:250–251. Scotcher S, Canning C, Nevill-Lamb R. ‘Lost’ contact lens presenting as an intraocular foreign body. Br J Ophthalmol 1995;79:97–98.
