Clinical Analysis of Perforating Globe Injuries with Intraorbital Foreign Bodies: An 18-Year Retrospective Study

Purpose: This study investigated the clinical characteristics, management strategies, and visual outcomes of perforating ocular injuries associated with intraorbital foreign bodies (IOrFBs). Methods: We retrospectively reviewed 54 patients with perforating ocular injuries and IOrFBs admitted to the Eye & ENT Hospital of Fudan University from January 1, 2007, to December 31, 2024. This study was reviewed and approved by the Ethics Committee of the Eye & ENT Hospital of Fudan University (Approval No. 2024146). Data collected included demographics, injury circumstances, foreign body composition, size and location (measured on preoperative computed tomography [CT] images), surgical approaches, and visual outcomes. Statistical analyses were performed using R, with significance set at p < 0.05. Results: Of the 54 patients, 87.0% (47) were male, and 92.6% (50) sustained occupational injuries (both p < 0.001). Ferromagnetic metallic fragments were the predominant cause (77.8%, 42). Anatomically, 40.7% (22) of foreign bodies were confined to the orbit, while 18.5% (10) involved the inferior globe wall and 16.7% (9) extended to the posterior pole. Larger IOrFB diameters were significantly associated with poorer preoperative and postoperative visual acuity ( p < 0.05). Surgical interventions were performed as either single-stage or staged procedures, depending on the severity of the injury. The surgical strategies included pars plana vitrectomy (PPV) alone without foreign body removal; PPV combined with IOrFB extraction; PPV followed by subsequent orbital surgery for foreign body removal; orbital surgery for foreign body extraction followed by subsequent PPV; and IOrFB extraction alone without PPV. The most common surgical approach was combined PPV with orbital surgery (35.2%, 19). Notably, surgical approach was not an independent predictor of final visual outcomes. Conclusion: IOrFBs primarily affect working-age men and are typically caused by occupational metallic trauma. Larger foreign bodies predict worse baseline and final vision, whereas foreign body location and surgical approach do not independently influence visual prognosis. These findings highlight the need for early detection, occupational safety measures, and individualized management to optimize outcomes. Keywords: open-globe injury, perforating ocular trauma, intraorbital foreign body, surgical strategy, visual acuity