Commotio Retinae - Perforating Foreign Body

This is a case of an ocular perforating foreign body. This patient was employed as a roofer and reported that during his work a piece of metal flew into his eye. The skin around his right eye had ecchymosis. His vision was hand motion (HM) in the right eye and 20/20 in the left. On examination there was blood in the vitreous of his right eye, obstructing the view of his retina. A B-scan ultrasound of his eye showed a perforating injury with an exit wound adjacent to the optic nerve (red arrow). He was advised to have vitrectomy surgery together with laser to remove blood and prevent further bleeding. The metal foreign body was not in the eye, but in the orbit, with no sign of infection. It did not need to be surgically removed. One month post-surgery, a fundus montage shows the exit wound (white arrow) and laser scars around the exit site (blue arrows). His retina was attached and within four months, his right eye vision returned to 20/40. Safety glasses are recommended for occupations that are at high risk for eye injuries.