Siderosis Bulbi Following a Retained Intraocular Foreign Body: A Delayed Threat to Vision

Abstract

Siderosis bulbi is a delayed ocular complication associated with the retention of a ferrous intraocular foreign body (IOFB), resulting from progressive iron deposition and toxicity to intraocular tissues. We present the case of a 25-year-old man with a retained metallic IOFB following penetrating ocular trauma sustained while hammering a wooden piece. B-scan ultrasonography demonstrated a highly reflective intraocular echo suggestive of a retained IOFB located in the inferior retinal region. Although surgical removal was considered indicated, definitive treatment was not initially feasible because of limited institutional resources. The patient was therefore temporarily managed with close observation and counselling regarding warning signs. One year after the initial injury, he developed severe visual deterioration, fixed mydriasis, pigment deposition on the anterior lens capsule, anterior chamber inflammation, and vitreitis, consistent with clinical siderosis bulbi associated with the retained metallic IOFB. Computed tomography (CT) subsequently confirmed a hyperdense metallic foreign body in the posterior segment. A 23-gauge pars plana vitrectomy was performed, and the IOFB was removed. Intravitreal and intracameral antibiotics were administered. Six days after surgery, best-corrected visual acuity (BCVA) improved to 0.1 logMAR. This case highlights the delayed clinical manifestations and potential visual consequences of a retained metallic IOFB and emphasises the importance of timely definitive management.