Eye Foreign Body

Aka: Eye Foreign Body, Foreign Body Involving the Eye, Ocular Foreign Body, Intraocular Foreign Body in Vitreous

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II. History

  1. Eye Protection (e.g. goggles)
  2. Injury Mechanism
    1. Grinding metals
    2. Welding
    3. Machinery (lawn mowers, string trimmers)
    4. Hammering
    5. Tree branch
  3. Past medical history
    1. Eye surgery history (e.g. Cataract Extraction, LASIK)
    2. Tetanus Immunization
    3. Contact Lens use

III. Exam

  1. Precautions
    1. Avoid direct eye pressure (e.g. lid eversion, Tonometry, Ultrasound) if Globe Rupture suspected
  2. General Eye Exam
    1. See Eye Trauma (includes Visual Acuity and full Eye Exam)
    2. Visual Acuity
    3. Extraocular Movements (disconjugate gaze, restricted eye movement or Cranial Nerve deficit)
    4. Pupil Exam (Pupillary Light Reflex, Anisocoria, tear-shaped pupil)
  3. Evaluate for significant globe or orbital Trauma
    1. Globe Rupture
    2. Enophthalmos (globe recession, e.g. orbital floor Fracture)
    3. Exophthalmos (globe protrusion, e.g. Retrobulbar Hematoma)
    4. Gross facial or Eye Trauma
  4. Slit Lamp Exam
    1. Corneal Foreign Body
    2. Corneal Abrasion (Fluorescein stain with cobalt blue light)
    3. Anterior cells and flare (irirtis or Uveitis)
  5. Evert the Eyelids to check for a Retained Foreign Body
    1. Use magnification (a small speck can cause significant pain)

IV. Imaging: Intraocular Foreign Body

  1. Orbital Ultrasound
    1. Contraindicated in Globe Rupture
    2. May help identify occult foreign body
      1. However, Exercise caution in applying pressure with probe
  2. CT Orbit with contrast
    1. First-line study for intraocular foreign body
    2. Test Sensitivity: 60-100% for identify foreign body
      1. Best efficacy for larger foreign bodies, glass, metal, stone
      2. Negative CT Orbits does not exclude foreign body
      3. Negative CT Orbit does NOT exclude Globe Perforation (Test Sensitivity 51-77%)
  3. MRI Orbit
    1. Contraindicated in suspected magnetic foreign body

V. Management: General

  1. See Eye Trauma
  2. See Periocular Foreign Body
  3. See Corneal Foreign Body
  4. See Conjunctival Foreign Body
  5. Tetanus Vaccine
  6. Analgesia for an intact globe (e.g. Corneal Abrasions >3 mm long)
    1. Ocular NSAIDs (e.g. Ketorolac Ophthalmic)
    2. Long acting Cycloplegic (e.g. .25% Isopto Hyoscine, Cyclopentolate)
      1. Avoid in shallow anterior chamber and closed angle Glaucoma
    3. AVOID Topical Anesthetics or steroids
      1. Interfere with epithelium healing
  7. Intraocular Foreign Body
    1. See Globe Rupture
    2. See Endophthalmitis
    3. Consult ophthalmology early, emergently
      1. CT orbit with contrast misses up to half of Globe Perforations (see above)
      2. Ophthalmology intervention within 24 hours improves outcomes
        1. Decreased Endophthalmitis risk
        2. Improved outcome in Visual Acuity
      3. Keep the patient NPO in preparation for surgery
        1. May use D5LR or D%NS to maintain hydration
    4. General Measures
      1. Cover affected eye with metal eye shield or cup
      2. Elevate head of bed to 30 degrees
      3. Administer Antiemetics (e.g. Ondansetron)
      4. Administer systemic Analgesics
    5. Broad-spectrum ParenteralAntibiotics to prevent Endophthalmitis
      1. Vancomycin AND
      2. Ceftazidime or Fluoroquinolone
    6. Special considerations in multisystem Trauma patients
      1. Rapid Sequence Intubation (RSI)
        1. Avoid Succinylcholine and Ketamine due to risk of increased introcular pressure
        2. Rocuronium with other induction agents (e.g. Etomidate) are preferred

VI. Complications: Intraocular foreign body

  1. Endophthalmitis (30%)
  2. Eye enucleation (8%)
  3. Complete Vision Loss (5%)

VII. Prevention

  1. See Eye Protection

VIII. References

  1. Baxter, Williams, Mehta (2025) Crit Dec Emerg Med 39(11): 28-35

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