The role of anterior segment optical coherence tomography in the management of an intra-corneal foreign body

Abstract

Introduction: Corneal foreign bodies are reported to be the second most common type of ocular injury. Anterior segment optical coherence tomography (AS-OCT) is a valuable tool for the early diagnosis and monitoring the progress of treatment in cases of ocular trauma. Herein we aimed to report on a patient with an intra-corneal foreign body and the role of AS-OCT in management.

Case presentation: A 34-year-old male presented with foreign body sensation in his left eye. Slit-lamp biomicroscopic examination revealed a peripherally located intrastromally embedded foreign body with a free anterior edge extending outwards from the cornea. It was not possible to visualize the foreign body's entire route through the cornea because of localized corneal edema. AS-OCT showed shadowing of the corneal layers corresponding to the location of the corneal foreign body. A hyper-reflective lesion was observed close to the inside edge of the foreign body in the cornea, indicating that the foreign body had not completely penetrated the cornea. The foreign body was removed via the external route, as it had not completely penetrated the cornea. During the postoperative period the patient was asymptomatic, although the left eye's cornea healed with scar tissue.

Discussion and evaluation: AS-OCT facilitates non-invasive rapid imaging of ocular tissue at va rious depths, thereby providing accurate assessment of foreign body characteristics.The location of an intracorneal foreign body and the status of the surrounding ocular structure dictate the optimal surgical technique to be employed.

Conclusions: AS-OCT in the present case facilitated localization and determination of the size of a corneal foreign body. In addition, AS-OCT findings assisted in selection of the appropriate surgical intervention.

Keywords: Anterior segment; Cirrus SD-OCT; Cornea; Foreign body removal; Spectral domain optical coherence tomography.

Fig. 1

Preoperative slit-lamp biomicroscopy of the patient’s left eye shows the embedded corneal foreign body

Fig. 2

Pre-operative AS-OCT images of the patient’s left eye. AS-OCT image shows hyper-reflectivity and shadowing due to the corneal foreign body (Left). AS-OCT image shows that the corneal foreign body did not completely penetrate the cornea (Right)

Fig. 3

Postoperative slit-lamp biomicroscopy of the patient’s left eye shows the cornea beginning to heal with scar tissue formation

Fig. 4

Postoperative AS-OCT image of the patient’s left eye shows hyper-reflectivity corresponding to corneal scar tissue