Man presents 18 hours after penetrating injury to left eye

A 51-year-old man with no significant ocular history presented to the Lahey Medical Center after sustaining a penetrating injury to the left eye during a home improvement project. The patient reported using a motorized wire brush to resurface a piece of sheet metal when an individual 16 mm wire broke free from the brush and penetrated his left cornea. The patient’s son immediately removed the intact wire with a pair of tweezers, and they visited a local urgent care center where he was prescribed tobramycin ointment. He was sent home with follow-up to see an ophthalmologist the next morning. The ophthalmologist then referred him to Lahey for further operative management. It had been 18 hours since the onset of injury by the time he was seen at Lahey.At the time of presentation, best corrected visual acuity was 20/70 in the left eye. The left pupil was already pharmacologically dilated on arrival. Slit lamp exam revealed a full-thickness corneal laceration less than 0.5 mm in diameter temporal to the central visual axis. The wound was briskly Seidel positive (Figure 1). The anterior chamber was shallow relative to the right eye and had 1+ mixed pigmented and white cells. There was an opacity in the crystalline lens that appeared similar to a cortical spoke, but this opacity obscured the view of the overlying anterior capsule; it was difficult to determine whether the anterior capsule had been violated at this point, creating a traumatic cataract underneath. Posterior segment exam revealed clear vitreous without evidence of foreign body. The fundus exam was unremarkable.