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Scleral foreign body OPHTHALMOLOGY X-RAY TRAUMA A patient presented to the emergency department with slight discomfort in the left eye and a new floater. On further questioning the patient revealed that he had been grinding a wire brush and was not wearing eye protection. On examination, his visual acuity was 6/6 6/12; on the slit lamp, he had mild conjunctival injection, and a small metallic foreign body (FB) was visible in the temporal aspect of the left sclera (figure 1). After attempts to remove the FB, the patient was referred to ophthalmology. Subsequent X-ray (figure 2) confirmed that the visible FB was just the tip of an intraorbital FB that had penetrated through the sclera. The patient was commenced on broad-

Figure 3

Figure 1 Scleral foreign body.

Metallic foreign body.

spectrum antibiotics and underwent a pars plana vitrectomy and removal of the FB (figure 3). This case highlights the high index of suspicion required for an intraorbital foreign body when there is a history of a high-impact trauma, for example, grinding metal, and the importance of imaging in such cases. Alexander Silvester, Sunlidath Cazabon Department of Ophthalmology, Countess of Chester Hospital NHS Foundation Trust, Chester, UK Correspondence to Dr Alexander Silvester, Department of Ophthalmology, Countess of Chester Hospital NHS Foundation Trust, Countess of Chester Health Park, Liverpool Road, Chester CH2 1UL, UK; [email protected] Contributors Both authors were involved in the management of the patient, and took the photographs. AS wrote the case report. Competing interests None. Provenance and peer review Not commissioned; internally peer reviewed.

To cite Silvester A, Cazabon S. Emerg Med J 2015;32:225.

Figure 2 Orbital X-ray with the patient looking up. Foreign body seen within the left orbit. Aksay E, et al. Emerg Med J 2015;32:221–225. doi:10.1136/emermed-2013-202971

Accepted 22 April 2014 Emerg Med J 2015;32:225. doi:10.1136/emermed-2014-203817 225

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Scleral foreign body Alexander Silvester and Sunlidath Cazabon Emerg Med J 2015 32: 225 originally published online May 14, 2014

doi: 10.1136/emermed-2014-203817 Updated information and services can be found at:

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