title: The role of in vivo confocal microscopy in the diagnosis of hidden corneal foreign bodies.
abstract: OBJECTIVE
  To investigate in vivo confocal microscopy (IVCM) to diagnose hidden corneal foreign bodies.
  
  
  METHODS
  Male Kunming mice (n = 25; 12 weeks old) were anaesthetized prior to the insertion of five different materials (spiny wood, rusty iron, sharp stone, sharp glass fragment and human hair fragment) into the cornea by different traumatic processes. A separate mouse was used for each corneal foreign body. The corneas of the mice were scanned 24 h later by a laser scanning IVCM to establish the characteristics (shape, reflectivity and depth in the cornea) of each foreign body. These findings were used to help screen and identify corneal foreign bodies in patients. Corneal smears and scraping cultures were performed in cases of probable corneal infection.
  
  
  RESULTS
  Animal models for the five different foreign particles were established successfully, with each showing distinctive characteristics. These animal results were used to diagnose 41 patients with suspected corneal foreign bodies who were negative by slit lamp examination, but positive by IVCM (observational case series). The most prevalent type of hidden foreign body was plant material (51.2%), followed by metal (29.3%). Ten patients with corneal foreign bodies developed fungal keratitis, found using IVCM.
  
  
  CONCLUSIONS
  Laser IVCM is an effective and reliable tool for the diagnosis of hidden corneal foreign bodies.
authors.affiliation: Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
authors.forename: Zhongzhong
authors.initials: Z
authors.lastname: Xu
authors.forename: Xiaofei
authors.initials: X
authors.lastname: Yu
authors.forename: Zhijie
authors.initials: Z
authors.lastname: Li
authors.forename: Liya
authors.initials: L
authors.lastname: Wang
mesh_terms: D000818:Animals; D003316:Corneal Diseases / Q000175:diagnosis*; D004195:Disease Models, Animal; D005547:Foreign Bodies / Q000175:diagnosis*; D008297:Male; D051379:Mice; D018613:Microscopy, Confocal / Q000379:methods*
keywords: Diagnosis; fungal keratitis; hidden cornea foreign body; in vivo confocal microscopy