Long-standing asymptomatic intralenticular foreign body.

Dear Editor,

Intralenticular foreign bodies are uncommon after penetrating eye injuries, occurring in approximately 5% to 10% of cases [1]. They generally present with a decrease in visual acuity resulting from aggravation of a traumatic cataract. In Korea, there has been only one previous report of an intralenticular foreign body, which was retained for 6 months [2]. Several previous reports documented the occurrence of intralenticular foreign body worldwide, but only two cases described asymptomatic intralenticular foreign body [3,4]. We recently experienced a case of asymptomatic intralenticular foreign body retained for 30 years, and report the case herein.

A 43-year-old man presented to our institution with discomfort in his left eye. He lost his right eye in a landmine blast in 1983. On examination, visual acuity was 20 / 20 and intraocular pressure was 9 mmHg in the remaining eye. Corneal opacity without involvement of the visual axis was observed, but there was no inflammation in the cornea or anterior chamber. After pupillary dilatation, slitlamp examination revealed an intact posterior lens capsule and an intralenticular foreign body in the form of a round, yellow-whitish lesion (Fig. 1). We assumed that the foreign body was metallic in nature. It was encapsulated by a membrane and had an estimated diameter of approximately 1.2 mm. Fundus examination revealed no abnormalities in the left eye. Since visual acuity was not significantly affected, close follow-up observation was the chosen course of management.

Fig. 1

Slit-lamp photography shows (A) corneal opacity (arrow) and (B) an intralenticular foreign body (arrow).

In small anterior lens capsule defects, epithelial proliferation rapidly restores its continuity, limiting the free passage of ions and fluid that may result in progressive cataract formation [5]. In our case, the size of the intralenticular foreign body was 1.2 mm and the capsular break was small enough to heal spontaneously. We believe that the foreign body remained stable because of encapsulation, although there was no pathologic confirmation of this. The visual axis was not involved. We believe that the reasons stated above explain why the patient did not experience any visual disturbance for 30 years despite the presence of an intralenticular foreign body.

In conclusion, we report a case of long-standing asymptomatic intralenticular foreign body. Conservative management of intralenticular foreign body is an acceptable course unless ocular complications, such as intraocular inflammation and cataract formation, occur.