II. Causes

  1. Work related particles (drilling, Sanding)
  2. Environmental (Sand, Dirt)

III. Symptoms

  1. Foreign body sensation
    1. "Trash in my eye"
  2. Foreign body feels as if it is moving
    1. Object usually lodged under upper lid and not mobile
    2. As patient blinks, different Cornea parts irritated

IV. Exam Techniques

  1. Inferior Cul-de-sac foreign body
    1. Patient looks up while lower lid pulled down
  2. Superior Cul-de-sac foreign body (Most common)
    1. Elevation of upper lid while patient looks down
      1. Usually not effective at visualizing foreign body
    2. Upper Eyelid Eversion

V. Signs

  1. Check Visual Acuity
  2. Fluorescein stain
    1. Helps localize foreign body (sand or other particle)
      1. Pinpoint dye uptake
    2. Helps localize secondary Corneal Abrasions
  3. Foreign body (usually on superior Conjunctiva)
    1. Carefully examine small sulcus under lid margin
      1. Frequent site of missed foreign body
  4. Corneal Abrasions
    1. Superior cul-de-sac foreign body
      1. Multiple vertical linear abrasions
      2. Confined to one quadrant of superior Cornea

VI. Management

  1. Removal of foreign body
    1. Irrigation
    2. Cotton swab moistened with topical anesthetic
      1. Sweep across lid Conjunctiva at foreign body site
  2. If no foreign body found
    1. Sweep both lid Conjunctivae with moist cotton swab
    2. May remove overlooked foreign body
  3. Indications to refer to ophthalmology
    1. Persistent symptoms (esp. glass fragment exposure)
    2. Difficult removal of foreign body
    3. Deep Laceration associated with foreign body

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