Morning Report: Eye Foreign Body Removal

Eye Foreign Body Removal

Immediately refer to an ophthalmologist in case of the following:

o Hyphema

o Diffuse corneal damage (focal or diffuse opacity)

o Scleral or corneal laceration

o Lid edema

o Posttraumatic dilation of pupil or abnormal shape of pupil

o Abnormally shallow or deep anterior chamber compared to the fellow eye

o Persistent corneal defect or corneal opacity

o Any case with possible full penetration of the cornea or sclera

Procedure

Apply a wet fluorescein strip inside the lower eyelid to instill fluorescein onto the cornea. Under ultraviolet light, examine the cornea to locate the foreign body.
Inspect the lower eyelid while the patient looks up
Inspect the upper eyelid by everting with an applicator while the patient looks down. Sweep the recesses of the upper conjunctival fornix.
If the foreign body is superficial, irrigate the eye to moisten the cornea and attempt to remove the foreign body by using a gentle rolling motion with a wetted cotton-tipped applicator. Take care not to apply pressure, which may push the foreign body deeper into the cornea, or scrape, which may create a large corneal abrasion.
An embedded foreign body cannot be removed with irrigation or with a cotton-tipped applicator.
An embedded foreign body can be removed by using a gentle flicking motion with an eye spud, if available, or with a 25- or 27-gauge needle. Approach the cornea from the side, with the needle in a plane tangent to the cornea and the bevel away from the corneal surface.
Document a negative Seidel sign after the foreign body is removed.

References:

Bashour, M. Corneal Foreign Body Removal. Emedicine Mar 5, 2014 http://emedicine.medscape.com/article/1195581-overview