Migration of intra-ocular foreign bodies.

THE migration of an intra-ocular foreign body, with or without its subsequent spontaneous extrusion from the eye, has been reported several times in the literature, though in few instances in any detail. It was first described by de Castelnau (1842), who recorded how a man sustained an injury to his right eye, followed, 3j years later, by the spontaneous extrusion through the cornea of a particle of iron measuring 13 mm. x 5 mm., and weighing 750 mg. His treatment of the eye during recurrent periods of inflammation while the foreign body was retained included cold compresses, leeches, and belladonna. Copper particles, however, are the most frequently concerned in this phenomenon. De Wecker (1896) noted a case in which, immediately after an injury, a foreign body was seen ophthalmoscopically in the right fundus near the macula. At the end of 4 weeks it was seen in the lower part of the vitreous, and its life-history, although complicated by the removal of a secondary cataract, was terminated only after it had perforated the iris and cornea some 4j years later. Blake (1931), the only writer to give details of an accurate x-ray localization, reported two cases, in each of which a piece of copper-wire migrated forwards; in the first, a piece of wire 3i mm. long moved in the course of 5 years from a position " 5 mm. behind the cornea" to the limbus in the six o'clock meridian; in the second, a piece of wire 5 x 2 x 2 mm. moved from a position " 4 mm. below the horizontal, 5 mm. to the temporal side of the vertical plane, and 10 mm. behind the cornea ", to the limbus, again in the six o'clock meridian. This latter case, however, was operated on unsuccessfully, when the foreign body was seen to be pushing the iris forwards, so that its history was not straightforward. Other cases in which migration followed by extrusion occurred between 1 and 5 years after injury have been noted by Kipp (1884), Rampoldi (1891), Meyer (1894), Hoesch (1895) and Erb (1899). A 7 to 10 year delay was reported by Hartley (1883) and Spechtenhauser (1894), 18 years by Lewis (1897), and 21 years by Raulin (1897). Kiiummell (1908) reported a case in which a copper particle weighing 2 75 mg. and measuring 1 -6 x 13 x '85 mm. moved from the upper posterior part of the globe until it caused the iris to bulge forwards; an iridectomy including the foreign body was performed, with a satisfactory result.