What might make you suspicious for a foreign body inside the eye?

Patients often present with small foreign bodies in the eye. It’s usually a small piece of metal flake from grinding or welding … debris seems to get in the hair and then fall into the eye.

Anytime you have a history of “metal on metal” such as when hammering or grinding, your suspicion must be high for an intraocular foreign body. A small piece of metal can travel at high speed and lodge inside the eye. The patient might not even have much pain from this, and there may be no obvious sign of an entrance wound seen. Metal is extremely toxic to the retina, and needs to be identified.

To rule out metal foreign bodies, the best modality is a good dilated retina exam and a CT with thin slices through the orbits.