JAMA Clinical Challenge

Decreased Vision Following Eye Trauma

A, Slit-lamp image of the dilated right eye demonstrating iris synechiae underlying a faint, self-sealing full-thickness corneal wound (arrowhead) (original magnification x1.0). B, Slit-lamp image on adduction of the dilated right eye, revealing a golden, intraocular foreign body within the lens (arrowhead) (original magnification x1.6).

Rajesh C. Rao, MD
Lynn J. Poole Perry, MD, PhD
A 52-year-old man presented to the emergency department (ED) for evaluation after several days of increasingly blurred vision in the right eye. Nine days earlier, while he was operating an asphalt reclamation machine, the patient reported the sensation of an object striking his right eye, but he had no acute pain or change in vision. He was not wearing eye protection at the time. One day after the trauma occurred, the patient visited his primary care physician and was prescribed topical antibiotics. His past medical and ophthalmological histories were unremarkable. On examination in the emergency department, the best corrected visual acuities were 20/100 in the right eye and 20/20 in the left eye. Dilated, slit-lamp examination of the right eye revealed a self-sealing, full-thickness corneal wound and an area of iris irregularity (iris synechiae formation) (Figure 1A), minimal anterior chamber inflammation, and early cataract formation. On adduction of the eye, a large, glistening, variegated intraocular foreign body was seen encased entirely in the crystalline lens (Figure 1B). There were no additional findings in the vitreous or retina on dilated examination, including no signs of endophthalmitis. Examination results of the left eye were unremarkable.

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Author Affiliations: Dr Rao (rajeshcrao{at}gmail.com) is affiliated with the Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Missouri. Dr Poole Perry is affiliated with the Department of Ophthalmology, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, Massachusetts.