CORNEAL FOREIGN BODIES

Question 1

KEY CONCEPTS

Answer 1

Rule out intraocular foreign body

CT Orbit Gold Standard to r/i intraocular foreign body

< 1 day, a superficial foreign body can likely be removed without leaving a rust ring.

> several days, there could be worsening pain, visual changes, and redness, which would be concerning for corneal infection or endophthalmitis.

Question 2

MANAGEMENT

Answer 2

FOREIGN BODY REMOVAL

Tetracaine 1-2 drops in affected eye

Irrigate with NS

Use slit lamp, keep light out of direct vision

Have patient fixate on another object

Dislodge with:

cotton applicator
OR
25-gauge needle (bevel up)
OR
Sterile foreign body spud (1 mm d) on an algar brush
THEN
Remove with moistened cotton applicator

RUST RING REMOVAL
Remove Superficial Rust Ring:
Sterile Foreign Body Spud (1 mm d) on algar brush
OR
Opthalmic Burr

DO NOT DO ED DRILL BURRING IF RUST RING IS LOCATED IN CENTRAL VISUAL AXIS

Refer to Optho if they can be seen within 24 hrs
POST REMOVAL MANAGEMENT
Cyclopentolate 1% Solution
1 drop in affected eye tid

Erythromycin 0.5% Ointment
Apply 1 cm ribbon to affected eye qid
5-7 days

Voltaren Opthalmic Solution
1 drop in affected eye qid

+/- Tetanus Immunization

INDICATIONS FOR OPTHO REFERRAL
Center axis of vision affected
Rust Ring

Question 3

DOCUMENTATION

Answer 3

HISTORY

Ask about:
Onset
Timing
Pain
Foreign Body Sensation
Visual Acuity - normal unless central
+/- photophobia
Watery discharge
Edema of eyelid

PHYSICAL EXAM

Rust Ring - metallic foreign body
Foreign Body > 24 hrs - white ring represents WBC infiltrate

Globe Penetration:
Hyphema in anterior chamber
+ve Seidel test