BACKGROUND: Management of posterior segment intraocular foreign bodies is challenging, requiring the preservation of ocular integrity and restoring vision. Traumatic endophthalmitis occurs in 7% to 13% of penetrating injuries, particularly with coexisting intraocular foreign bodies. Managing posterior segment intraocular foreign bodies poses significant challenges due to their complex clinical presentation and the need to achieve multiple goals during treatment. This unusual case of a large metallic intraocular foreign body associated with traumatic cataract, retinal detachment, and endophthalmitis underscores the challenges of diagnosis and management.

CASE REPORT: A 31-year-old man presented with pain and vision loss in the left eye 7 days after penetrating trauma by a metallic foreign body. Examination showed visual acuity 20/20 (logMAR 0.00) in the right eye and hand movement (logMAR 3) in the left. There was a full-thickness inferior 2-mm corneal laceration with iris incarceration, anterior chamber reaction with fibrinous exudation, and a traumatic cataract, with no retinal view. Imaging confirmed the presence of an intraocular foreign body and endophthalmitis with an associated rhegmatogenous retinal detachment at the time of vitrectomy. The 35-mm foreign body was successfully removed. However, the intraocular foreign body was not detected initially on B-scan ultrasonography, reflecting the diagnostic and therapeutic challenges, as well as the importance of computed tomography imaging.

CONCLUSIONS: This case report highlights the complexity of managing a large retained intraocular foreign body, underscoring the rarity of its size, complicated by endophthalmitis, traumatic cataract, and rhegmatogenous retinal detachment, emphasizing the importance of multimodal imaging, individualized treatment approaches, and continued research to improve management of similar conditions.

Keywords: Cataract, Endophthalmitis, Eye Injuries, Penetrating, Intraocular Foreign Bodies, Retinal Detachment, Vitrectomy