X-ray turns a blind eye to ferrous metal

The case is reported of a 31-year-old man with a retained metallic intraocu lar foreign body (IOFB) in the left eye who underwent magnetic resonance im aging (MRI) for investigation of a subsequent unrelated brachial plexus inj ury. Despite the patient providing good history of IOFB, the decision to pr oceed with MRI was based on screening orbit X-ray which was reported as nor mal. A review of published reports regarding screening recommendations for MRI for patients with IOFB is provided. A minimum recommendation is for pre screening questionnaire; belief of the patient history is critical. If ther e is any doubt after history and examination by an ophthalmologist, then co mputed tomography imaging of the orbits is recommended. Whether screening b y plain X-ray imaging is worthwhile is debatable as the sensitivity and spe cificity of this modality is poor.