See Also
1. Eye Foreign Body
Pathophysiology
1. Usually clipped or broken metallic particles
2. Particles embed in Cornea with significant force
Management
1. Check Visual Acuity prior to removal
2. Apply topical anesthetic to affected eye
3. Attempt removal with sterile saline irrigation
  1. Flow directed toward foreign body may dislodge it
4. Attempt removal with damp sterile cotton swab
5. Attempt removal with spud or 25 gauge needle
  1. Best performed under slit lamp visualization
6. If unable to remove
  1. Patch Eye
  2. Refer to Ophthalmology
7. Prophylactic topical antibiotic coverage
  1. Apply 4 times daily until epithelium heals
8. Analgesia for abrasions >3 mm long
  1. Long acting Cycloplegic (e.g. .25% Isopto Hyoscine)
  2. AVOID Topical anesthetics or steroids
    1. Interfere with epithelium healing
9. Reevaluate patient in 24 hours
  1. Signs of infection
  2. Adequate healing without signs of Corneal Ulcer
    1. Fluorescein staining should resolve by 72 hours
Ophthalmology referral indications
1. Difficult Foreign Body Removal
2. Rust Ring formation at Cornea
3. Signs of perforation of globe with foreign body
4. Signs of Corneal Ulcer formation
  1. Haze at base of Corneal defect
  2. Fluorescein staining persists >72 hours
5. Central Corneal defects
Complications
1. Rust Ring
  1. Occurs with iron foreign bodies
  2. Onset in 2-4 hours after embedding
  3. Complete rust ring forms in 8 hours
  4. Requires Ophthalmologist removal with hand drill
2. Prolonged foreign body
  1. Infection risk if embedded >2-4 days
    1. Results in Corneal Ulceration and scarring
  2. Requires Ophthalmology referral
3. Globe Perforation
  1. Anterior chamber appears more shallow
  2. Leakage of fluid from site of foreign body embedding

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.