One of the untouched topic in IOFB, will help u guys who r stuck with finding presentstion on this topic. #each one teach one series

1. IOFB LOCALISTAION
SUMMARISED

2. ELECTRICAL METHOD OF LOCALISATION
BURMAN LOCATOR
ROPER HALLS LOCATOR
CARNAYS LOCATOR
OPHTHALMOMETTALOSCOPE OF HALE

3. IMAGING TECHNIQUES
• DIRECT RADIOGRAPH METHOD
• GEOMETRIC RECONSTRUCTION
 Sweet`s Method
 Mackinzie Method
 Dixon Method
• LIMBAL RING TEST
• CONTACT LENS METHOD
 COMBERGS METHOD
 WORST LOVAC CONTACT LENS

6. SIDEROSIS & CHALCOSIS
• Siderosis Bulbi is PIGMENTORY
& DEGENRATIVE change in
foreign body containning iron.
• Pathological Anatomy first
described by Von Hippel (1894).
• Suggested 2 types of Siderosis :-
1.Haematogenous 2.Exogenous.

7. • Corrosion is the destruction of a
metal resulting from its contact with
a liquid.
• Factor which increase the velocity of
corrosion are presence of oxidizing
agents , uneven surfaces of the metal
, higher temperature & greater
alkalinity .
• Human eye offers an optimal
situation for corrosion.

8. HOW IRON AFFECTS??
• Chemical process in ocular siderosis have been debated for years.
• Von Graefe (1860) thought that iron diffuses in form of oxides.
• Leber(1882) thought iron bicarbonate is formed, which is oxidized and
pecipitated in ocular tissue.
• Friedenwald (1954) believed that stainning of tissues by iron is due to to ferric
ions in low concentration which combine with sulph-hydryl groups in the cells.
• AAO writes that Oxidation & dissemination if Ferric ions throughoput the eye
promotoes Fenton reaction,which leads to formation of Hydroxyl ions.
 These hydroxyl ions causes Lipid peroxidation , sulfhydryl oxidation &
depolymerization with cell membrance damage & enzyme inactivation.

9. PATHOLOGY
• Epithelium of ciliary body is the
first tissue affected and the non-
pigmented epithelium stains earlier.
• Iris is affected at the anterior
limiting layer & in the sphincter &
dilator muscles.
• Macrophages laden with iron
pigments are commmonly found in
trabecular meshwork.
• RPE is invariable affected .
• The ganglion cells are involved &
macrophages laden with pigment
surround the retinal vessels.

10. !!!INTERESTING !!!
• The site of foreign body governs both the rate and extent of
tissue stainning.
• Process is rapid when the metal is bathed in ocular fluids and
slow when it lies in tissues of low metabolism such as lens &
cornea.
• Rupture of lens capsule & bruschs membrane facilitates the
disruption of iron.

11. CLINICAL FINDINGS
Latent Period:- Before clinical signs manifest,
varies from few weeks to many years (2weeks
to 2 years) depnding upon site & nature of FB
Spread of iron through the ocular tissue. The
diffusing iron stains all epithelial structures
with which it comes in contact.
Degenration of the tissues,in particular
Retina, due to toxic effect of iron.

16. SYMPTOMS
• Nyctalopia *(Early Symptom)
• Decreased Vision
• Concentrically constricted visual
field.
SIGNS
• Pupillary mydriasis & poor reactivity.*
(Earliest sign)
• Rust coloured corneal stainning at entry
points.
• Iris hetrochromia (as more iron deposit
in musculature of iris)
• Brown deposit on anterior lens.
• Cataract (only if penetration is there)
• Vitreous opacities
• Peripheral retinal pigmentation (Early)
• Diffuse Retinal Pigmentation (Late)
(appearance confused with RP)
• Narrowed Retinal Vessels
• Optic disc discoloration & atrophy
• Secondory open angle glaucoma from
iron accumulation in trabecular
meshwork.

17. INVESTIGATIONS
• Slit lamp Photo & Fundus Photo
• B-Scan
• ERG
• CT Scan
• X-Ray

18. INVESTIGATIONS

20. • Full-field ERG is the most common means
for detecting OS and all patients should
have this prior to surgical intervention .
• Iron retinotoxicity leads to a dysfunction of
all the layers of the retina with more severe
damage occurring in the inner retina than in
the outer retina in the late stages of the
disease .
• In the early phase, both the a-wave and the
b-wave, though more commonly the former,
can be transiently increased. As siderosis
progresses, the b-wave decreases, causing
the b-wave/a-wave ratio to fall.
• Rod-dominated responses are predominantly
affected as they have a greater susceptibility
to iron toxicity compared to the cone system
.
• Improvement in ERG with removal of an
IOFB has been documented by several autho

22. HISTOPATHOLOGIC
< 85 % COPPER
CHALCOSIS
ACUTE
(<= 3 WEEKS)
CHRONIC
(1OR MORE
YEAR)
>85 % COPPER
DUKE`S ELDER
SUPPURATIVE CHRONIC NON
GRANULOMATOUS
REACTIVE FIBROSIS DISSEMMINATED
COPPER
DEPOSITION

23. • Tend to deposit in Basal Layer as compared to siderosis which preferred epithelial layer.
• IOFB with high copper content involves violent endophthalmitis often with progression to
phthisis bulbi Alloys with low copper content like brass and bronze results in chalcosis
• Kayser-Fleischer ring is golden brown ring which occurs due to deposition of copper under
peripheral part of Descemet’s membrane of the cornea
• Sunflower cataract produced by deposition of the capsule under posterior capsule of the
lens.Brilliant golden green in colour

24. • Retina – deposition of golden plaques at the posterior pole which reflects light
with a metallic sheen
• Degenerative retinopathy does not develop as it is less retinotoxic compared to
iron

25. INVESTIGATIONS
• Slit lamp Photo & Fundus Photo
• B-Scan
• ERG
• CT Scan
• X-Ray

26. TREATMENT
SIDEROSIS
• Remove the FB
• Galvanic deactivation.
• Administration of IV EDTA.
• Sub.Conj injection of ATP
• Administration of
Desferrioxamine which
traps free ions & converts
into non-toxic chelate.
CHALCOSIS
• Remove the FB
• Sodium Thiosulphate
• BAL (British Anti-Lewsite)

27. • Pathology of eye trauma is of immense interest as many of the changes in the eye and
adnexa are different from the pathology of other part of the body . An understanding of
the nature of activity of different FBs are important for medico legal purposes and in
determining its nature, need for urgent removal.
• HOW MANY OF U AGREE TO THIS POINT???

28. • In this series, most of the iron FBs which had larger size caused significant damage to the
structures, consistent with other studies .
• Iron FB lodged in crystalline lens caused microscopic changes in the lens capsules and the
adjoining areas.
• Retinal pigment epithelium (RPE) showed degenerative changes with iron FB.
• Copper FB was seen and documented in SEM and EDX .Pure copper usually produces a
suppurative reaction and alloys of 80% copper or less may subsequently lead to chalcosis
• Zinc and aluminum IOFBs are toxic and should be removed immediately
• It is always urgent and mandatory to remove the vegetable IOFBs because they usually
contain microorganisms that can lead to endophthalmitis and cause excessive inflammation .
• Glass and plastic IOFBs are often well tolerated; they may be retained indefinitely in many
cases if there is no surrounding damage and if it is immobile .
• In some cases, stone fragments may be well tolerated but the risk of seeding with micro-
organisms merits their prompt removal
• Sympathetic ophthalmia is characterized by granulomatous pan-uveitis following penetrating
injuries of the globe which can be accidental or surgical.

29. • Wound length is predictive of the risk of retinal injury.
• A small external wound is suggestive of retinal damage as less of the IOFBs energy is
dissipated during penetration, allowing it to reach and injure the retina.
• Foreign bodies entering the eye through sclera are more damaging than the corneal
wound of entry.
• Retained IOFBs exhibit long-term toxicities like siderosis and chalcosis which may lead
to retinal pigmentary changes and retinal toxicities as seen in our pathological samples

32. WHAT,IF U WERE THERE AT
GMCH ,KASHMIR!!!!
MANAGEMENT OF IOFB

33. • Video

35. BRONSON
ELECTROMAGNET.

36. LANCASTER WORKING
CRITERIA FOR A MAGNET
It states that to be EFFECTIVE , A giant Magnet should pull steel
bale of 1mm diameter with a force of over 50 TIMES its weight at a
distance of 20mm

39. REFERENCES
• Management of Ocular Siderosis: Visual Outcome and Electroretinographic Changes
Naresh B. Kannan, Olukorede O. Adenuga, Renu P. Rajan, and Kim
Ramasamy.
• SIDEROSIS BULBI* BY J. F. BALLANTYNEt From the Department of Ophthalmology,
University of Toronto. Brit. J. Ophthal. (1954) 38, 727.
• Das D, Misra DK, Bhattacharjee H, Kapoor D, Deka H, et al. (2017) Pathological Significance
of Ophthalmic Foreign Bodies. Adv Ophthalmol Vis Syst 7(3): 00225. DOI:
10.15406/aovs.2017.07.00225
• Chalcosis in the Human Eye A Clinicopathologic StudyNarsing A. Rao, MD; Mark O. M.
Tso, MD; A. Ralph Rosenthal, MD
• Pictures from Google search engine.
• Ryan 6th edition Intraocular Foreign Body management.
• FAQ in ophthalmology.
• Thanks DR.AMU & DR.DIVAKANT SIR for inputs..

40. • THANK YOU EVERYONE FOR PATIENTLY LISTENING TO THIS SEMINAR.
• For feedbacks & brickbats plz mail at
• ykush@yahoo.co.in./drdhir2014@gmail.com
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