Foreign Body in the Anterior Chamber Presenting as Inflammatory Mass on the Iris

A 40-year- old male factory worker presented to our eye clinic with left eye pain, redness and blurring of vision, associated with history of an injury sustained while hammering a nail into the wall three days ago. He had mild symptoms at the onset of the injury. Slit lamp examination of left eye showed a small, self-sealed laceration corneal wound at the temporal limbus and a smooth, well defined, oval mass on the iris in the anterior chamber in the lower temporal quadrant. Rest of the anterior segment and fundus were normal. X-ray orbits showed no intraocular foreign body in the left eye. In view of clinical suspicion, we proceeded with a CT scan of orbits which showed the presence of a small metallic foreign body in the anterior chamber of left eye. After giving topical antibiotic, cycloplegic, and corticosteroid eye drops along with systemic antibiotics for three days, we planned surgical removal of the mass in the anterior chamber. After the mass was removed, we noted a small metallic foreign body embedded within the fibrin mass. The same treatment was continued postoperatively. The left eye became white and quiet, and vision improved to 6/6 with above treatment. The key learning point presented is that when the history is suggestive of intraocular foreign body, even though the X-ray orbits does not show the foreign body one has to get CT scan of orbits done to rule out its presence, especially when there is inflammatory mass in the anterior chamber as seen in our case.