II. Pathophysiology

  1. Usually clipped or broken metallic particles
  2. Particles embed in Cornea with significant force

III. 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 25 gauge needle tip (or similar spud)
    1. Brace hand against patient's face
    2. Position 25 gauge needle parallel to the Corneal surface, approaching from lateral aspect
    3. Use magnifying loops (or Slit Lamp)
    4. Gently flick out the foreign body
    5. Some use battery operated burr tool to remove ocular foreign bodies
      1. Many ophthalmologists do not recommend this due to the potential for significant Corneal damage and scarring
  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

IV. Management: 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

V. 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. Burr tool is available in many Emergency Departments
      1. However risk of Vision Loss if Bowman's Membrane is disrupted
      2. Consider application or antibiotic ointment (e.g. Erythromycin) and referral to ophthalmology for the next day
  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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