The Role of Computed Tomography in Ophthalmic Surgeon Tactics in Shrapnel Wounds to the Eyeball. Clinical Case

There is a clinical case of eyeball metallosis in the background of a foreign body of the posterior segment of the eye in the article. Patient N, 41, complained of a gradual decrease in vision of the right eye. A duration of open injury to the right eye about eight years ago. At the primary ophthalmic examination, the most corrected visual acuity of the right eye was 0.3. The visual acuity of the left eye was 1.0. Intraocular pressure according to pneumotonometry: OD — 13 mm Hg, OS — 14 mm Hg. According to biomicroscopy of the right eye, it was found: the skin of the eyelids is unchanged, the conjunctiva is hyperemic, the mixed reaction of the vessels, the cornea is transparent, spherical, shiny, the anterior chamber is transparent, uneven, the iris is changed in color, foci of stroma hyperpigmentation are observed, the pupil is deformed, narrowed, displaced along the meridian for 1 hour, artificial. Examination of the central and peripheral parts of the fundus is difficult due to deformation and narrowing of the pupil diameter. Due to difficulty performing ophthalmoscopy, the patient underwent the following studies: static perimetry, ultrasound biomicroscopy (UBM) of the anterior segment of the eyeball, electrophysiological examination, B-­scan, computed tomography of the eyeball and orbit. The static perimetry revealed a concentric narrowing of the OD field of view. According to the ultrasound biomicroscopy, the IOL dislocation was revealed anteriorly. В­-Scanning visualizes the blistering cystic edema of the retina, inside which the induration is determined, giving an acoustic shadow. The electrophysiological examination showed changes in the electrical sensitivity and lability of the retina. According to the results of CT in the vitreous cavity, a foreign body was detected in the lower segment along the meridian 6 hours. In accordance with this, the diagnosis was made: OD — metallosis of the eye. Foreign body of the eye.

1. Petraevskiy AV, Gndoian IA, Trishkin KS, Vinogradov AR. Ocular traumatism in Russian Federation. Vestnik Oftalmologii. 2018;134(4):80–83 (In Russ.). doi: 10.17116/oftalma201813404180.

2. Pismenskaya VA, Kislitsyna NM. Surgical treatment of penetrating osseous oblique wounds with involvement of the posterior segment of the eyeball. Practical medicine. 2012;4(59):167–171 (In Russ.)

3. Sozurakova EA, Gromakina EV, Novoselova VM, Tretiak EA, Shakhmatov KS. Analysis of penetrating eye wounds in five years. Viewpoint. East‑West. 2020;3:52–54 (In Russ.).

4. Guelfguat M, Kaplinskiy V, Reddy SH, DiPoce J. Clinical guidelines for imaging and reporting ingested foreign bodies. AJR Am J Roentgenol. 2014 Jul;203(1):37–53. doi: 10.2214/AJR.13.12185. Erratum in: AJR Am J Roentgenol. 2014 Sep;203(3):694. DiPoce, C Jason [corrected to DiPoce, Jason].

5. Gundorova RA, Brovkina AF, Bagaturia TG, Valsky VV, Bykov VP. Diagnostic value of computer tomography in post‑traumatic surgery of eyes complicated wounds. Annals of Ophthalmology 1986;102(6):45–47 (In Russ.).

6. Filatova IA, Tishkova AP, Beraya MZ, Polyakova LYa, Tkhelidze NR. Computer tomography in diagnostics and treatment tactics determination in patients with posttraumatic eye and orbital pathology. Annals of Ophthalmology. 2005;6:9–14 (In Russ.).

7. Amosov VI, Speranskaya AA, Lukina OV. Multispiral computed tomography (MSCT) in ophthalmology. Ophthalmological reports. 2008;1(3):54–59 (In Russ.).