Demystifying the role of magnetic resonance in identifying intraocular foreign bodies: a case of ocular siderosis.
Cataract
Computed tomography (CT)
Intraocular foreign body (IOFB)
Magnetic resonance imaging (MRI)
Ocular siderosis
Vision loss
Vitrectomy
Journal
BMC ophthalmology
ISSN: 1471-2415
Titre abrégé: BMC Ophthalmol
Pays: England
ID NLM: 100967802
Informations de publication
Date de publication:
26 Aug 2024
26 Aug 2024
Historique:
received:
26
06
2024
accepted:
19
08
2024
medline:
27
8
2024
pubmed:
27
8
2024
entrez:
26
8
2024
Statut:
epublish
Résumé
Ocular siderosis (OS) is a significant cause of visual loss due to retained ferrous intraocular foreign bodies (IOFB). Despite its rarity, OS can lead to severe visual impairment if not promptly diagnosed and treated. This case is notable due to the occult nature of the IOFB, which was undetected by standard imaging modalities, emphasizing the critical role of magnetic resonance imaging (MRI) in such scenarios. A 51-year-old Caucasian male presented with progressive vision loss in his right eye over 20 days. Best corrected visual acuity (BCVA) was 20/1000 in the right eye and 20/20 in the left eye. Intraocular pressure (IOP) was 9 mmHg in both eyes. Slit-lamp examination revealed a small linear corneal wound and an iris defect in the right eye, along with a cataract featuring brownish deposits on the anterior capsule. The left eye was normal. Fundus examination of the right eye was hindered by media opacities. Ultrasonography showed a flat retina and choroid with no detectable IOFB. Despite a strong clinical suspicion of OS, computed tomography (CT) did not detect any IOFB. MRI subsequently identified an artifact in the inferior sectors of the right eye, indicative of a metallic IOFB. Surgical intervention involved a 23-gauge vitrectomy, phacoemulsification, IOFB removal and silicon oil (SO) tamponade resulting in a fully restored VA of 20/20 and normal IOP one month post-operation. SO was removed 2 months later. The retina remained adherent with no PVR development, and optical coherence tomography (OCT) scans showed a normal macula. This case underscores the importance of considering OS in patients with unexplained vision loss and history of ocular trauma, even when initial imaging fails to detect an IOFB. MRI proved crucial in identifying the IOFB, highlighting its value in the diagnostic process. Early detection and surgical removal of IOFBs are essential to prevent irreversible visual damage. This case demonstrates that MRI should be employed when CT and ultrasonography are inconclusive, ensuring accurate diagnosis and timely intervention to preserve vision.
Sections du résumé
BACKGROUND
BACKGROUND
Ocular siderosis (OS) is a significant cause of visual loss due to retained ferrous intraocular foreign bodies (IOFB). Despite its rarity, OS can lead to severe visual impairment if not promptly diagnosed and treated. This case is notable due to the occult nature of the IOFB, which was undetected by standard imaging modalities, emphasizing the critical role of magnetic resonance imaging (MRI) in such scenarios.
CASE PRESENTATION
METHODS
A 51-year-old Caucasian male presented with progressive vision loss in his right eye over 20 days. Best corrected visual acuity (BCVA) was 20/1000 in the right eye and 20/20 in the left eye. Intraocular pressure (IOP) was 9 mmHg in both eyes. Slit-lamp examination revealed a small linear corneal wound and an iris defect in the right eye, along with a cataract featuring brownish deposits on the anterior capsule. The left eye was normal. Fundus examination of the right eye was hindered by media opacities. Ultrasonography showed a flat retina and choroid with no detectable IOFB. Despite a strong clinical suspicion of OS, computed tomography (CT) did not detect any IOFB. MRI subsequently identified an artifact in the inferior sectors of the right eye, indicative of a metallic IOFB. Surgical intervention involved a 23-gauge vitrectomy, phacoemulsification, IOFB removal and silicon oil (SO) tamponade resulting in a fully restored VA of 20/20 and normal IOP one month post-operation. SO was removed 2 months later. The retina remained adherent with no PVR development, and optical coherence tomography (OCT) scans showed a normal macula.
CONCLUSIONS
CONCLUSIONS
This case underscores the importance of considering OS in patients with unexplained vision loss and history of ocular trauma, even when initial imaging fails to detect an IOFB. MRI proved crucial in identifying the IOFB, highlighting its value in the diagnostic process. Early detection and surgical removal of IOFBs are essential to prevent irreversible visual damage. This case demonstrates that MRI should be employed when CT and ultrasonography are inconclusive, ensuring accurate diagnosis and timely intervention to preserve vision.
Identifiants
pubmed: 39187820
doi: 10.1186/s12886-024-03649-6
pii: 10.1186/s12886-024-03649-6
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
374Informations de copyright
© 2024. The Author(s).
Références
Ballantyne JF. Siderosis Bulbi. Br J Ophthalmol. 1954;38(12):727–33.
doi: 10.1136/bjo.38.12.727
pubmed: 13219251
pmcid: 1324441
Masciulli L, Anderson DR, Charles S. Experimental ocular siderosis in the squirrel monkey. Am J Ophthalmol. 1972;74(4):638–61.
doi: 10.1016/0002-9394(72)90826-4
pubmed: 4116414
Shaikh S, Blumenkranz MS. Fluorescein angiographic findings in ocular siderosis. Am J Ophthalmol. 2001;131(1):136–8.
doi: 10.1016/S0002-9394(00)00718-2
pubmed: 11162994
Steel DH, Rosseinsky DR, James CR. Acute retinal toxicity caused by the bimetallic electrochemical action of a galvanized steel intraocular foreign body. Retina. 1998;18(1):77–9.
doi: 10.1097/00006982-199818010-00017
pubmed: 9502289
Ta CN, Bowman RW. Hyphema caused by a metallic intraocular foreign body during magnetic resonance imaging. Am J Ophthalmol. 2000;129(4):533–4.
doi: 10.1016/S0002-9394(99)00435-3
pubmed: 10764867
Rao SK, Nunez D, Gahbauer H. MRI evaluation of an open globe injury. Emerg Radiol. 2003;10(3):144–6.
doi: 10.1007/s10140-003-0303-6
pubmed: 15290503
Chacko JG, Figueroa RE, Johnson MH, Marcus DM, Brooks SE. Detection and localization of steel intraocular foreign bodies using computed tomography. A comparison of helical and conventional axial scanning. Ophthalmology. 1997;104(2):319–23.
doi: 10.1016/S0161-6420(97)30317-0
pubmed: 9052639
Moisseiev E, Last D, Goez D, Barak A, Mardor Y. Magnetic resonance imaging and computed tomography for the detection and characterization of nonmetallic intraocular foreign bodies. Retina. 2015;35(1):82–94.
doi: 10.1097/IAE.0000000000000266
pubmed: 25077536
Casini G, Sartini F, Loiudice P, Benini G, Menchini M. Ocular siderosis: a misdiagnosed cause of visual due to ferrous intraocular foreign bodies-epidemiology, pathogenesis, clinical signs, imaging and available treatment options. Doc Ophthalmol. 2021;142(2):133–52.
doi: 10.1007/s10633-020-09792-x
pubmed: 32949328
Zhang Y, Cheng J, Bai J, Ren C, Zhang Y, Gao X, et al. Tiny ferromagnetic intraocular foreign bodies detected by magnetic resonance imaging: a report of two cases. J Magn Reson Imaging. 2009;29(3):704–7.
doi: 10.1002/jmri.21637
pubmed: 19243045
Kannan NB, Adenuga OO, Rajan RP, Ramasamy K. Management of ocular siderosis: visual outcome and electroretinographic changes. J Ophthalmol. 2016;2016:7272465.
doi: 10.1155/2016/7272465
pubmed: 27073692
pmcid: 4814669
Hope-Ross M, Mahon GJ, Johnston PB. Ocular siderosis. Eye (Lond). 1993;7(Pt 3):419–25.
doi: 10.1038/eye.1993.83
pubmed: 8224298