Background: To report on the diagnosis and management of a"firecracker" injury presenting with a post-traumatic intraocular inflammation.
Case report: A 10-year-old boy sustained a penetrating 16-mm cornea-sclera blast injury to his left eye with uveal prolapse and hemophthalmus and doubtful light perception. The cranial computed tomography revealed a metallic intraocular foreign body (IOFB), retinal detachment, and subretinal and subchoroidal hemorrhage. After primary wound closure and antibiotic treatment for 1 week, increasing cell infiltration and amaurosis developed, and a lensectomy, pars plana vitrectomy, and extraction of the 17x7x7-mm encapsulated IOFB via a scleral tunnel was indicated.
Results: A vitreous specimen did not reveal microbial growth; however, plenty of polymorphonuclear cells, macrophages, and lymphocytes were observed. Spectroscopy of the IOFB showed copper, zinc, silicon, lead, and other metals. A diagnosis of noninfectious inflammation due to heavy metals, primarily copper (=chalcosis), was made. The postoperative course was unremarkable, the intraocular lens in place, fundus CDR 0.2, retina and macula attached, intraocular pressure 9 mmHg. Three weeks after surgery, the flash VEP showed absent potentials.
Conclusions: Large projectiles or parts should be removed from the eye immediately in order to prevent complications from toxic metallosis and early fibrotic reactions.