Management and Clinical Outcomes of Eyes With Posterior Segment Intraocular Foreign Bodies Seen at a Tertiary Referral Center.

BACKGROUND AND OBJECTIVE: This study aimed to identify the prognostic factors regarding the visual and anatomic outcomes of eyes with posterior segment intraocular foreign body (PS-IOFB). PATIENTS AND METHODS: The medical records of 95 patients who underwent pars plana vitrectomy and PS-IOFB removal between 2004 and 2021 were retrospectively reviewed. Data on anatomical and visual outcomes, as well as preoperative, intraoperative, and postoperative variables were statistically analyzed. RESULTS: The mean age of the patients was 31.9 ± 12.3 years. The mean follow-up time was 21.9 ± 28.3 months. The median time interval from trauma to IOFB removal was 9 days. In univariate analysis, there was a positive correlation between initial visual acuity (VA) and final VA (P < 0.001). A higher ocular trauma score (OTS) was significantly associated with both anatomical and functional success (P < 0.001). Linear regression analysis showed that OTS was not superior to initial VA in predicting final VA (r = 0.625 vs r = -0.601). Anatomic and functional outcomes were not affected by the injury site, nature of PS-IOFB, or timing of PS-IOFB removal (P > 0.05 for all). Subretinal IOFB location, the need for silicone oil tamponade, and endophthalmitis (P = 0.005, P < 0.001, P = 0.044, respectively) were risk factors for poor visual outcome. CONCLUSIONS: The initial VA, the extent of the initial ocular damage, and the presence of endophthalmitis are important prognostic factors for functional success. [Ophthalmic Surg Lasers Imaging Retina 2024;55:434-442.].

Visual outcomes and prognostic factors of early pars plana vitrectomy for open globe injury.

OBJECTIVES: To identify the clinical features and outcomes of early vitrectomy in patients with open globe injury (OGI) and the prognostic factors for visual outcome. METHODS: This retrospective observational case series included 390 eyes in 389 patients diagnosed with OGI receiving vitrectomy within four days after injury. Preoperative parameters included the injury types, wound locations, consequent tissue damages, initial visual acuity (VA), and ocular trauma score. Postoperative outcome measures included surgical procedures, retinal (re)attachment, complications, and final VA. The logistic analysis evaluated the prognostic factors for visual outcome. RESULTS: Intraocular foreign bodies (59.2%) and penetrating injuries (28.7%) were the most common injury types. Among the 165 eyes with retinal detachment (RD), 121 (73.3%) had retinal reattachment during early primary vitrectomy, and 32 (19.4%) were repaired during a second or subsequent surgery. Thirteen eyes (3.3%) were enucleated. The final VA improved from the initial level in 207 eyes (55.2%), remained unchanged in 123 (32.8%), and decreased in 45 (12.0%). Multivariable regression revealed that the injury zone, initial VA, RD, and endophthalmitis were associated with poor visual outcomes (P < 0.05). CONCLUSIONS: Higher zone injury, low initial VA, RD, and endophthalmitis are predictors of poor visual outcome in eyes undergoing early vitrectomy for OGI.

Long-term ophthalmic anatomical and functional outcomes after surgical removal of intraorbital foreign bodies.

PURPOSE: To analyze the anatomical and functional ophthalmic parameters after the surgical removal of various intraorbital foreign bodies. METHODS: A retrospective analysis of medical records was performed featuring detailed history, ophthalmic examination, orbital computed tomographic scans, treatment details, and outcomes. The analyzed anatomical factors included extraocular movements, the position of the eyeball (proptosis, dystopia, and enophthalmos), and fullness of orbital sulci. The functional assessment was based on visual acuity, pupillary reactions, and diplopia. The outcomes were defined as complete, partial, and failure after a minimum follow-up of 1 year. RESULTS: Of 32 patients, the organic and inorganic intraorbital foreign bodies were surgically removed from 18 (56.25%) and 14 (43.75%) orbits, respectively. At presentation, anatomically the extraocular movement restriction, proptosis/dystopia/enophthalmos, and orbital sulcus fullness were noted in 26 (81.25%), 24 (75%), and 15 (46.88%), respectively. Functionally, diminished visual acuity, diplopia, and pupil abnormalities were seen in 27 (84.38%), 14 (43.75%), and 8 (25%), respectively. After intraorbital foreign body removal at a mean follow-up of 14 months, the improvement of anatomical factors (same sequence) were observed in 8 (30.77%), 20 (83.33%), and 12 (80%), respectively. In functional factors (same sequence), the improvement was noted in none (0%), 13 (92.86%), and 5 (62.5%), respectively. Hence, the majority of patients (n = 20, 62.5%) achieved partial success, while 8 (25%) had complete success. Four (12.5%) had treatment failure despite similar management protocols. CONCLUSION: The anatomical outcomes are better than the functional outcomes after surgical removal of the intraorbital foreign bodies. The visual acuity does not improve considerably after the surgical removal of intraorbital foreign bodies. Overall, the wooden intraorbital foreign bodies have poorer anatomical and functional prognosis.

[Corneal perforation due to 'lost' contact lenses]. / Corneaperforatie door 'zoekgeraakte' contactlenzen.

An 87-year-old woman with Alzheimer's disease was referred to our eye clinic with a large corneal perforation of her right eye. On further examination a total of 15 contact lenses were found under the upper eyelid of her right eye; several lenses were also found in her left eye. During further evaluation we learned that our patient had experienced severe, recurrent and painful blepharoconjunctivitis for the past 3 years, for which she had consulted several ophthalmologists and other medical practitioners. The last time our patient had inserted a contact lens was more than 3 years previously. We therefore concluded that the retained contact lenses had caused an infectious ulcer which led to a corneal perforation. The patient underwent a perforating keratoplasty, which restored the eyesight in her right eye. Removal of the retained contact lenses gave our patient relief from her severe chronic eye pain.

Electrophysiological findings in delayed discovery of a metallic intraocular foreign body in a child: case report.

PURPOSE: To report a case of a child with strabismus and delayed discovery of a metallic intraocular foreign body with good recovery of visual acuity and stereopsis with 36-month follow-up. METHODS: A 4-year-old girl was evaluated due to exotropia of right eye initiated 9 months before with progressive worsening. Visual acuity was 1.00 logMAR (20/200) in the right eye and 0.00 logMAR (20/20) in the left eye. Anterior segment evidenced a small paracentral corneal leukoma, posterior synechia and mild lens opacity in the temporal quadrant only in the right eye. Fundus examination in the right eye identified the presence of an intraocular foreign body, with appearance of metallic components surrounded by retinal pigmented endothelial cells atrophy. Full-field electroretinography (ERG) showed reduced amplitudes and delayed implicit times for both rods and cones in the affected eye. All tests were normal in the fellow eye. RESULTS: Pars plana vitrectomy was promptly performed in the right eye, followed by phacoemulsification with intraocular lens implantation 4 months later due to worsening of the lens opacification. The full-field ERG was repeated after the surgical procedures. The ERG showed mild worsening of all responses in the right eye. After 36 months of follow-up, visual acuity was 0.20 logMAR (20/32) with improvement of the ocular misalignment and with 60 s of arc stereopsis with ERG responses unchanged. CONCLUSION: In this young girl perforating ocular trauma with metallic material was lately diagnosed with strabismus as a sign of alert. Prompt surgical intervention and proper management were essential to provide reasonable visual function including some degree of stereopsis, even though retinal dysfunction characterized by ERG was persistent.

Detection and monitoring of subclinical ocular siderosis using multifocal electroretinogram.

BACKGROUND: Although full-field electroretinogram (ffERG) is the gold standard test to detect physiological dysfunction in siderosis, it measures overall retinal function. This study aims to determine if multifocal electroretinogram (mfERG) can detect subclinical siderosis in eyes with an iron intraocular foreign body (IOFB). METHODS: Twenty eyes of 20 patients with retained iron IOFB, clear ocular media and good visual acuity (≥20/120) were enroled in this prospective case-control study. The fellow eyes served as control. These were evaluated with ffERG and mfERG at baseline. Serial mfERG was done till six months after pars plana vitrectomy with IOFB removal. Primary outcomes measures were amplitude and peak time of P1 and N1 wave of mfERG. RESULTS: The median age was 25 years (range 18-55). Most patients (n = 14/20) presented within a month of trauma. Baseline ffERG showed no difference in either 'a' or 'b' wave amplitude or peak time between cases and controls. However, on mfERG, there was a significant decrease in P1 and N1 wave amplitude and delay in P1 wave peak time in <2° retinal ring in cases as compared to controls (p = 0.001, 0.001 and 0.02 respectively) despite variability in results. At 6 months, P1 amplitude showed significant improvement from baseline in cases (p = 0.010). However, P1 peak time did not show significant recovery (p = 0.65). CONCLUSIONS: mfERG may reveal subclinical electrophysiological retinal dysfunction in eyes with iron IOFB in cases with normal ffERG. P1 peak time may serve as an electrophysiological marker for past retinal damage.

The Joint Pathology Center/Vision Center of Excellence Approach to Analyzing Intra-Ocular "Foreign Bodies".

BACKGROUND: The Military Health System recognizes the importance of analyzing "foreign bodies" removed from US service members through several policy documents. This activity focuses on detecting potentially toxic metals. Intra-ocular "foreign bodies" (IOFBs) represent a small, clinically important subset. The development of ocular metallosis with iron and copper fragments is a specific local reaction to IOFBs. The results of the compositional analysis of removed IOFBs can influence clinical management decisions aimed at optimizing the preservation of sight. METHOD: The Joint Pathology Center (JPC) and Vision Center of Excellence (VCE) have established a pathway for the analysis of IOFBs removed from Department of Defense and Veterans Health Administration patients. The analysis of IOFBs uses analytical methods to provide information about the fragments' surface elemental and molecular composition. RESULTS: Metallic specimens analyzed included iron and copper-containing fragments. Non-metallic IOFBs analyzed include glass, plastic (polyurethane), and nitro-cellulose fragments. CONCLUSION: The JPC/VCE approach to analyzing IOFBs promotes uniform handling and shipping of specimens to minimize contamination. The analytical approach allows for the characterization of IOFBs with a wide variety of compositions. The results support clinical management decisions aimed at optimal treatment for the preservation of patients' visual acuity.

Ant Bites Conjunctival Tissue: The ABCs of Removing an Ocular Ant Foreign Body.

BACKGROUND: A variety of insect-related ocular injuries have been reported in the literature. However, no reports have been published documenting injuries resulting from exposure of the ocular surface to ants. This is surprising, given the relatively ubiquitous presence of ants. This is the first known case report to describe various techniques utilized in the removal of ants from the ocular surface. CASE REPORT: This case report details the presentation of a distressed 24-year-old woman who presented to the Emergency Department with an ocular foreign body associated with pain and increased lacrimation. She was identified to have an ant adherent to her conjunctiva. Various techniques of removal were performed, with the ant finally removed without any trauma to underlying tissues. CONCLUSION: This is the first case report to detail various techniques utilized in the removal of ants from the ocular surface, and discusses salient features that treating physicians should be aware of in managing patients presenting with ant bites.

Predictive factors of visual outcome in posterior segment intraocular foreign body.

BACKGROUND: To identify the predictive factors for visual outcomes of patients with posterior segment intraocular foreign body (IOFB) after open-globe injury. METHODS: A retrospective, interventional study was conducted to evaluate consecutive patients with retained posterior segment IOFB who underwent vitrectomy over a 10-year period from 2007 to 2016. Multivariate linear regression analysis was used to identify the potential predictive factors for final visual outcomes. RESULTS: Forty-two patients were evaluated, with predominantly males (97.6%) and mean age 37.21 years. Hammering on metal (47.62%) was the major mechanism of injury. The majority of foreign bodies were metallic (95.24%) with a mean dimension of 4.3 mm. Twenty-four (57.14%) patients initially presented with a Snellen visual acuity <6/60. After surgery, 19 (45.24%) eyes had final visual outcomes of 6/12 or better; however, visual outcomes worse than 6/60 were documented in 17 (40.48%) eyes. Multivariate linear regression analysis revealed that the occurrence of retinal detachment (RD; p<0.01) and larger IOFB dimension (p=0.02) independently predicted worse final visual outcomes after adjusting for age and initial VA. Eyes with entry wounds located posteriorly into the sclera significantly increased the risk of RD compared to eyes with entry wounds involving cornea only (p=0.03). There was no association between time interval for IOFB removal and development of endophthalmitis. CONCLUSION: RD and larger IOFB dimension are significant predictive factors associated with worse final visual outcomes. Increased time to IOFB removal is not associated with either a higher risk of endophthalmitis or worse visual outcomes.

Pattern of ocular injuries in Bangladesh and its surgical management at hospital setting: A retrospective study.

OBJECTIVE: To determine the pattern of ocular injuries and their surgical management.. Methods: The retrospective study was conducted at the Chittagong Eye Infirmary and Training Complex, Chittagong, Bangladesh, and comprised hospital data of patients with ocular injuries from October 1, 2016, to December 31, 2017. Information gathered related to type and cause of injuries, visual acuity, postoperative complications, follow-up visits, and outcome. SPSS version 22 was used for data analysis. Results: Of the total injuries, 370 (91%) were classified open globe and 36 (9%) as close globe. In terms of type of injury, 330 (81.4%) were penetrating, 30 (7.3%) ruptured globe, 29 (7.1%) lime burn and 17 (4.2%) injuries were traumatic hyphaema and chemical in nature. Open globe injuries were mostly found in subjects aged 18 years or below. Surgery was the main mode of management in 388 (95.5%) patients. Conclusion: Preventive measures along with high-quality management should receive priority for reducing monocular blindness.

Open globe and penetrating eyelid injuries from fish hooks.

BACKGROUND: A few case reports have described accidental eye injuries caused by fish hooks. The severity of ocular injuries is dependent on the involved ocular structures. Severe ocular injuries due to fish hooks are rare. We describe open globe and penetrating eyelid injuries from fish hooks at the Baltic Sea. METHODS: Nine patients with traumatic ocular injuries caused by fish hooks were included. The following parameters were evaluated: severity of injury, best corrected visual acuity at admission and last follow-up, and surgical treatment. RESULTS: All nine patients were male. Age ranged between 7 and 51 years with a median of 13 years. Sixty-seven percent of the patients were children. Four of the nine patients were 9 years or younger. In 5 eyes (55%) the injury was limited to the eyelid. An open globe injury was found in 4 patients (45%). The mean follow-up was 16.7 ± 32.8 months. All patients required surgical treatment. The number of operations ranged from 1 to 3, with a mean of 1.4. At admission and last follow-up, patients with eyelid injuries showed a median best corrected visual acuity (BCVA) of logMAR 0.0. Patients with open globe injuries showed a median best corrected visual acuity of logMAR 1.5 at admission, and of logMAR 0.6 at last follow-up. CONCLUSIONS: Nearly half of the patients suffered severe penetrating injuries. Especially children misjudge the risk potential of fishing due to their lack of experience. Fishing glasses should be worn not only for UV protection, but also as injury prevention strategy.

Clinical characteristics and prognostic factors of posterior segment intraocular foreign body in a tertiary hospital.

BACKGROUND: To identify the clinical characteristics, prognostic factors and visual outcomes in posterior segment IOFBs patients managed by PPV in a tertiary hospital. METHODS: A retrospective chart review was performed for 56 patients, who had PPV for IOFBs removal between November 2013 and November 2015. The mechanisms of injury, the nature of the IOFBs, the BCVA before and after the surgery, the penetrating site and the complications of the surgery were all collected. Univariate analyses were conducted to evaluate the prognostic factors. RESULTS: The mean age of the patients was 36.4 years. The nature of IOFBs was mainly metal. Most injuries were commonly caused by hammering the metal. The mean preoperative VA was 2.30 logMAR, and mean final VA was 0.92 logMAR. From univariate analysis, good visual outcome was correlated with the good visual acuity before surgery and poor visual outcome was correlated with the macular break and multiple surgeries. CONCLUSIONS: In a tertiary hospital of eastern China, most cases of IOFBs were work-related. The prognosis of the patients was really well in the patients with good presenting visual acuity. Nevertheless the prognosis was not good for those patients who had macular injury or underwent several surgeries because of retinal detachment, epiretinal membrane or proliferative vitreous retinopathy. Good facilities for eye protection are urgently in demand for the workers indeed.

Effect of time to primary repair on final visual outcome after open globe injury.

BACKGROUND/AIM: Historic data suggest that open globe injuries should be repaired within 12-24 hours to reduce the risk of endophthalmitis. However, endophthalmitis is uncommon when systemic antibiotic prophylaxis is given. It is not clear whether delayed primary repair impacts visual outcomes in other ways or what is the optimum time to repair. We aimed to examine the effect of time to primary repair on visual outcomes. METHODS: This is a retrospective comparative case series including all open globe injuries presenting to the Birmingham Midland Eye Centre between 1 January 2014 and 15 March 2016. Presenting features, mechanism of injury, visual acuity at 6-12 months and demographic data were examined. RESULTS: 56 open globe injuries were repaired, of which sufficient data for analysis were available on 52 cases. The mean time to primary repair was 1 day after injury (range 5 hours to 7 days). Final visual acuity at 6-12 months was related to the presenting visual acuity and the Ocular Trauma Score and to the time between injury and primary repair, with a reduction in predicted visual acuity of logarithm of the minimum angle of resolution of 0.37 for every 24 hours of delay (95% CI 0.14 to 0.6). DISCUSSION: Open globe injuries should be repaired promptly. Presenting visual acuity remains the strongest predictor of outcome; however, delay to primary repair also reduced final visual acuity, and any significant delay from injury to repair is likely to negatively impact final visual outcome.

Intraocular Foreign Body Trauma in Operation Iraqi Freedom and Operation Enduring Freedom: 2001 to 2011.

PURPOSE: We update the incidence of intraocular foreign bodies (IOFB) in soldiers admitted to Walter Reed Army Medical Center from 2001 to 2011 after sustaining combat injuries in Operation Iraqi Freedom and Operation Enduring Freedom. DESIGN: This consecutive retrospective case series included 890 eyes of 652 patients. METHODS: Data were collected in the Walter Reed Ocular Trauma Database. Inclusion criteria were any American soldier or Department of Defense civilian with an IOFB injured in Operation Iraqi Freedom/Operation Enduring Freedom. Closed globe injuries with orbital foreign bodies, injury outside of a combat zone, or non-Department of Defense civilian trauma were the exclusion criteria. MAIN OUTCOME MEASURES: Primary outcome measures were final visual outcome and the number, size, and location of IOFBs. Secondary outcome measures included surgical procedures, use of eye protection, associated complications, source of injury and Ocular Trauma Score. RESULTS: There were 890 eye injuries in 652 patients evacuated to Walter Reed Army Medical Center between 2001 and 2011. IOFBs were found in 166 eyes of 149 patients (18.6%; 95% confidence interval [CI], 16.2%-21.3%). Most patients had a single IOFB (80.7%). An IOFB was positively associated with Ocular Trauma Score grade 1 or 2 (0-65) injuries (odds ratio [OR], 1.58; 95% CI, 1.07-2.38; P = 0.01). There were 130 eyes (78.33%) that had recorded time from initial visual acuity to final visual acuity and it ranged from 8 to 2421 days (mean, 433.24 days). Thirty-eight (25.16%; 95% CI, 18.89%-32.67%) eyes had no change in visual acuity, 98 (64.90%; 95% CI, 57.00%-72.07%) had improved visual acuity, and 15 (9.93%; 95% CI, 6.01%-15.84%) had decreased visual acuity. IOFB was not found to predict final visual acuity of <20/200 in multivariate analysis when other injury features were known (P = 0.1). Pars plana vitrectomy was completed on 124 eyes (74.70%). Removal of IOFB was performed in 118 eyes (71.08%; average of 31.67 days after initial injury) with a delayed procedure occurring after primary closure and antibiotics owing to a lack of surgical capacity in Iraq and Afghanistan. Retinal detachment occurred in 48 eyes (28.92%) and proliferative vitreoretinopathy in 44 eyes (26.5%). CONCLUSIONS: IOFBs occur frequently in combat ocular trauma and are significantly associated with more severe injuries. However, IOFBs were not found to be a significant risk factor for visual acuity of <20/200.

Prophylactic Chorioretinectomy in Open Ocular Trauma: A Series of 36 Eyes.

PURPOSE: The aim of this paper was to report the outcomes of prophylactic chorioretinectomy in open-globe injuries where a foreign body penetrated the choroid or perforated the globe. METHODS: We conducted a retrospective, consecutive, noncomparative, and descriptive study of patients registered in the ocular trauma database between January 2006 and December 2014, who underwent vitrectomy with chorioretinectomy. RESULTS: Thirty-six patients (33 male, 3 female) with a mean age of 40 years and a median of follow-up of 13 months were included. Twenty-one cases had penetrating globe injuries with an intraocular foreign body and 15 cases had perforating globe injuries. A concomitant chorioretinectomy was performed in all eyes, although it was only partial in 8 eyes. At the end of follow-up, proliferative vitreoretinopathy (PVR) rates were 6.5%, anatomical success was 80.6%, and the globe survival rate was 96.8%. CONCLUSION: Prophylactic chorioretinectomy is a surgical procedure that may decrease posttraumatic PVR, thus improving final visual acuity and increasing globe survival rates.

A missed diagnosis of multiple intraocular foreign bodies for 21 years.

A 30-year-old patient went to the emergency department because of a chemical burn to the left eye more than 10 days ago by toilet cleanser. Surprisingly, a small piece of glass was found in the inferior anterior chamber in the same eye. The visual acuity was counting fingers. There was conjunctival congestion, corneal oedema and Descemet's membrane striae. And there was also a corneal leukoma around 4 to 5 o'clock. Through repeated questioning he recalled that he was injured by an exploded light bulb around 21 years ago. He was asymptomatic until he saw "something moving" in front of the left eye one month ago. Computed tomography (CT) scanning, ultrasonography, ultrasound biomicroscopy (UBM), anterior segment optical coherence tomography (AS-OCT) verified the presence of multiple intraocular foreign bodies (IOFBs) in the anterior chamber and vitreous cavity. B-scan verified the IOFB in the vitreous cavity. Thus, he was diagnosed with corneal chemical burn, IOFBs and corneal leukoma of the left eye. The IOFB in the anterior chamber was removed through surgery. An attempt was made to remove the IOFB in the vitreous cavity with electromagnet, but it was not successful. Vitrectomy could not be performed as it was hindered by the opacity of cornea. After surgery, the visual acuity remained counting fingers and the corneal oedema still existed. This case is a reminder that a detailed history taking, a thorough physical examination and modern imaging techniques are beneficial for establishing the diagnosis and treatment of IOFBs.

Lawn mower injuries as a cause of serious visual acuity impairment - Case reports.

[b]Abstract Objective.[/b] The aim of the study is to present four cases of lawn mowers injuries as a cause of serious visual acuity impairment. [b]Materials and Method[/b]. A retrospective study of four patients admitted in 2013-2015 to the Department of Vitreoretinal Surgery in Lublin with severe open or closed globe injury, one with an intraocular foreign body (IOFB). The presence of eye protective equipment was assessed, as well as visual acuity, eye tissue condition before and after treatment, and applied therapy. RESULTS: In all cases an improvement was achieved in local conditions. The intraocular foreign body was removed, wounds sutured and damaged tissues placed in position. All eyeballs were saved. In three cases, visual acuity was improved to a usable level. Three patients underwent pars plana vitrectomy, one with IOFB removal from the vitreous cavity. [b]Conclusions[/b]. Lawn mower induced eye injuries are a significant cause of serious visual acuity impairment or blindness. The presented study shows that lawn mower eye injuries are still a therapeutic, social and economic problem, yet are very preventable with proper eye protection and patients' education. Current prevention strategies are inadequate, and therefore should be updated.

Orbital and Orbitocranial Trauma From Pencil Fragments: Role of Timely Diagnosis and Management.

PURPOSE: To emphasize the importance of early detection and radiologic evaluation of retained organic foreign bodies (FBs) in orbital or orbitocranial penetrating injuries by pencil. DESIGN: Retrospective case series. METHODS: A retrospective chart review of patients who had penetrating orbital or orbitocranial trauma at 2 tertiary hospitals was conducted. Patients whose mechanism of injury was penetrating trauma by pencil were included. The patients' demographics, time between initial trauma and detection of foreign body, radiologic images, and resulting sequelae were reviewed. RESULTS: Four patients were included in this study. All patients were male; 3 were less than 2 years of age and 1 was 34 years old. Accidents were witnessed in 2 cases, and initial detections of FBs were delayed in 3 cases, from 2 days to 7 weeks. Three cases involved the right orbit. Computed tomography (CT) imaging of the head demonstrated penetration of the orbital walls in 3 cases. Three-dimensional CT scans were used to differentiate the penetrating graphite pencil fragments from the orbital wall, and catheter angiography was used in 1 case of suspected orbital apex penetration. Vision was lost in 1 patient while other severe neurologic deficits were fully recovered after removal of FB. CONCLUSIONS: Penetrating injury by pencils to the periorbital structures and delayed detection of retained pencil fragments can result in threat to life and vision. Radiologic examinations are essential to the detection of these retained FBs. Prompt detection and removal of the FBs within 48 hours and treatment with antibiotics can save vision and life.