Introduction 1 1 5 2 6 10 Methods A detailed retrospective review was conducted of all patients who presented to King Khaled Eye Specialist Hospital, a JCIA (Joint Commission International Accreditation, USA) accredited tertiary eye care referral center in Riyadh, Saudi Arabia, from January 1983 to August 2004 with penetrating ocular trauma and retained intraocular foreign bodies (IOFB). Methods of IOFB extraction has varied during these years. For simplicity, the study period was divided into the first decade from 1983 to 1993 and the second decade from 1994 to 2004. For the past decade pars plana vitrectomy has been used more often for the posteriorly located IOFBs. Prior to removal of the foreign body (FB) all adhesions around the FB were released and it was freed from encapsulation where indicated. All IOFBs were removed by using IOFB forceps. Where necessary the sclerotomy was enlarged to facilitate easy removal of the FB. Endophotocoagulation was applied to the retina adjacent to the site of the IOFB. After removal of the FB, vitrectomy was utilized to remove any remains of FB capsule or fibrous tissue with the vitrectomy cutter. Only those eyes which showed any clinical evidence of endophthalmitis after trauma and retained IOFB were included in the study. Patients demographic studied included, age at presentation, sex, place of trauma, occupation, mode of injury and time between injury and repair. Other parameters included initial and final best corrected Snellen visual acuity, entry and location of IOFB and associated cataract, vitreous hemorrhage, retinal detachment, development of endophthalmitis, diagnostic studies performed, treatment rendered, type and size of IOFB. Complications such as cataract, retinal detachment and secondary procedures performed were also noted. Causes of visual loss such as corneal scarring, cataract, retinal detachment, retinal scars and loss of an eye were also investigated. In particular, all eyes with a retained IOFB and associated endophthalmitis were investigated and analyzed in detail. P Results 1 2 1 P P Table 1 Reported incidence of endophthalmitis with IOFB Studies Eyes with endophthalmitis (total eyes) Percent 11 11 (103) 10.7 12 10 (198) 5.1 3 14 (105) 13.3 5 14 (297) 4.7 1 34 (492) 6.9 4 13 (96) 13.5 Present study (Chaudhry et al.) 44 (589) 7.5 Table 2 Presenting and final visual acuity of patients with IOFB and endophthalmitis Visual acuity (VA) Presenting Final 20/20–20/60 3 11 20/80–20/200 5 9 20/400–CF 6 4 HM–LP 30 10 NLP 0 10 VA CF HM LP NLP Fig. 1 Patient with endophthalmitis associated with retained intraocular foreign body  1 Staphylococcus Streptococcus Hemophilus, Bacillus, Pseudomonas, Eikenella, Corynebacterium, Propionebacterium acnea Escherichea coli Bacillus, Pseudomonas Corynebacterium 2 3 P P Fig. 2 Patient with light perception vision after treatment of endophthalmitis and removal of intraocular foreign body  Fig. 3 Patient with phthisical left eye and no light perception after treatment of endophthalmitis and removal of intraocular foreign body  Discussion 1 2 1 3 5 13 1 1 1 1 14 4 1 3 5 14 12 4 15 2 1 4 16 17 17 13 17 13 3 18 18 18 3 19 15 19 20 3 18 21 22 18 21 In conclusion, the data from this retrospective study reiterate the importance of prompt recognition of retained IOFBs and early repair of related injuries to prevent endophthalmitis and associated complications of visual loss. Final vision appears to be considerably determined by the presenting VA and severity of injury. Eyes with IOFBs in the anterior segment appear to have better prognosis compared to eyes having IOFBs in the posterior segment. Early vitrectomy at the time of IOFB removal may be beneficial for overall visual outcome of the operated eyes. Owing to the retrospective nature of our study and most of the reported studies and the various types of injuries in different settings, results from these studies are difficult to compare. It is hoped that with the advent of modern instruments such as wide-angle viewing systems and high-speed cutters, the chances of complications such as retinal detachment may be greatly reduced. A multi-center prospective study may be required to address some of the confounding factors in the management of IOFB and associated endophthalmitis.