An Itch to Dilate: A Case Report of an Intralenticular Foreign Body in a 57-Year-Old Man

A 57-year-old man presented with a foreign body sensation in the left eye after using a metal pellet air gun seven days prior. Following an unremarkable exam at urgent care, the patient was prescribed topical ointment and instructed to follow up with an ophthalmologist for continued problems. At ophthalmology, the patient reported decreased vision of 20/30 and pain with accommodation in the left eye. Intraocular pressure was 16 mmHg. A slit lamp examination of the left eye showed full thickness horizontal scarring superior to the visual axis with a negative Seidel sign. The iris was normal, and the anterior chamber was deep and quiet. There was a slight abnormal aberration of light in the lens on retro-illumination. After dilation, a large metallic foreign body inferiorly embedded in the anterior lens was noted, violating the anterior capsule. The foreign body was successfully removed using a magnetic probe. Following lens phacoemulsification and the removal of cortical material, the capsular bag was noted to be intact. An intraocular lens implant was placed and well-centered. The patient experienced no complications, and his vision improved to 20/20 the subsequent day. This case report demonstrates the need for high clinical suspicion of embedded foreign bodies in patients near high-speed projectiles and the importance of dilation to rule out the presence of intralenticular foreign bodies.