[High-energy ocular trauma and changes in vision: a reason for a careful search for an intraocular foreign body]

A 50-year-old man visited his family physician one day after he had felt something entering his left eye following the blow of a metal hammer on metal, after which he began to see black spots. After the eye had been occluded for 4 days, his visual acuity had decreased to 0.1. Ophthalmologic examination revealed a defect in the cornea and iris, a foreign body in the vitreous and local cataract. Following surgical removal of the metal splinter and the lens, the visual acuity was restored to 0.8. Implantation of an artificial lens was planned. Ocular trauma is a major cause of permanent visual loss or blindness in (young) adults in the western world. Traumas in which a foreign body is propelled into the eye with high energy are most likely to penetrate the sclera. Damage and complications due to intraocular foreign bodies may lead to loss ofvision. The entry site of an intraocular foreign body may be difficult to find and the diagnosis may be missed. Therefore, an ophthalmologist should be consulted in case of a high-energy trauma in combination with visual loss.