Postoperative iris foreign bodies.

Foreign material usually gains access to the interior of the eye as a result of a perforating injury and a very wide variety of intraocular objects has been recorded, the commonest being iron or steel tool fragments which make up approximately go per cent. of the total (Duke-Elder, I954). Accidental introduction by the surgeon during any intraocular operation is always possible and it is perhaps surprising that this has not been noted more often. In the course of cataract extraction, the surgical technique includes many procedures such as elevation and inspection of the wound, introduction of various instruments into the eye, irrigation of the intra-ocular tissues with different solutions, swabbing and drying of the operative field, suturing of wound edges, generation of a negative pressure during lens removal, and instillation of drops or ointment into the conjunctival sac-and any or all of these may lead to contamination with foreign material. Amongst the foreign bodies reported as having entered the eye in this way have been multiple pieces of rubber from the inside of an irrigating bulb, Doherty (I 928) and Brockhurst (1952); cotton and lint threads from swabs or the atmosphere, Mukai (I926), Purtscher 0939), Vail (1950); eye ointment, Tietze (I943), Binder (1947), Sykowski (I950); the glass tip of an irrigator, Smith (I948); gold plating from an erisophake, Tennenbaum (I 955); and silk sutures, James (I 950) . Micro-organisms may also be classified as foreign material. The effect on the eye of these different particles depends on their size, shape, position, and constituents so that some have remained inert for many years while others have provoked a marked reaction necessitating further surgical intervention. The ease with which cotton fibrils and glove powder grains can reach the operative site was shown by Duszynski (I950) when he examined enucleated eyes which had had previous glaucoma operations and demonstrated the presence of talc granules in 157 of the 2I6 eyes sectioned. These were most apparent under polarized light and were situated in the episcleral and subconjunctival tissues stimulating a giant-cell inflammatory response. The present paper describes four cases in which, at a variable period after operation, tiny flecks of foreign material were seen resting on the iris, producing no untoward effect. These resembled metallic fragments on initial examination, but subsequent analysis in two of the patients disproved this.