Conjunctival and Corneal Foreign Body Removal


INDICATIONS
  • Small, conjunctival or corneal foreign bodies embedded less than 24 hours
CONTRAINDICATIONS
  • Foreign bodies embedded in the cornea for more than 24 hours (i.e., risk of infection)
  • Iron-based foreign bodies, which may cause a rust ring (relative contraindication)
  • Uncooperative patient
  • Deeply or centrally embedded foreign bodies (i.e., ophthalmologic referral)
  • Possible acid or alkali contamination of the eye (i.e., ophthalmologic emergency)
  • Ruptured globe (i.e., ophthalmologic emergency)
  • Hyphema, lens opacification, abnormal anterior chamber examination, or irregularity of the pupil (i.e., possible ruptured globe, which is an ophthalmologic emergency)
  • Signs or symptoms of infection (i.e., ophthalmologic referral)

 

EQUIPMENT
The following equipment is necessary for extraocular FB removal:
  • Topical anesthetic, such as proparacaine 0.5%
  • Sterile cotton-tipped applicators
  • Fluorescein strips
  • Magnification: loupes plus a Wood’s lamp, Eidolon BLUMINATOR ophthalmic illuminator or a slit lamp
  • Eye spud or 25-gauge needle attached to a 1- or 3-mL syringe or to the tip of a cotton-tipped applicator
  • Dilator drops, such as homatropine 5%
  • Antibiotic ointment, such as erythromycin
 
 

(1) C heck the patient's visual acuity using a Snellen chart, and have the patient lie down in the supine position.

 

(2) Hold the patient's eyelids apart with the thumb and index finger of your nondominant hand, and ask the patient to fix and maintain his or her gaze on a distant object.



(3) Apply 2 drops of topical anesthetic into the retracted lower eyelid while the patient gazes in an upward direction.
PITFALL: Putting drops directly on a scratched cornea can be very painful.
PITFALL: Vertical scratches on the cornea may indicate a foreign body imbedded in the upper lid, necessitating eyelid eversion and examination with a cotton-tipped applicator.


 

(4) Attempt to wash out the object using sterile saline or an ophthalmic irrigant.




(5) If irrigation is unsuccessful, attempt to dislodge the object using a cotton-tipped applicator moistened with local anesthetic.
PITFALL: Never use force or rub the cornea because this can produce pain, damage the epithelium, and cause deeper corneal injuries.


 


(6) If the object is still lodged, use the tip of a sterile, 26-gauge needle to gently lift the object.
PITFALL: If the object cannot be readily removed, refer the patient for removal under slit lamp by an ophthalmologist.
PITFALL: If any residual corneal rust is found, immediately refer the patient to an ophthalmologist because rust is toxic to corneal epithelium.



(7) After the object is removed, turn the patient's head laterally, and copiously irrigate the eye.