Foreign Bodies

Definition:  Metallic, or organic material under the upper or lower lid

Signs/Symptoms:  

• Foreign body sensation

• Tearing

• Foreign body in eye with and without a rust ring

• Conjunctival injection

• Mild upper lid edema.

Causes:  metallic material blown in the eye from drilling, or grinding metal.  Patient generally not wearing safety glasses at time of injury. 

Differential diagnosis:  trauma,

Evaluation: 

• Visual acuity

• History of injury.  

  • Determine if injury occurred secondary to metal striking metal (might indicate an intraocular foreign body)

• Document visual acuity.  

  • May need to instill ocular anesthetic to perform test. 

• Observe for foreign object on cornea and on conjunctiva.  

• Evert the lids to look for foreign body.  

  • Fluorescein may expedite this process, as it pools around foreign objects

• If intraocular foreign body is suspected then medvac as soon as possible 

Treatment:

• Apply topical anesthetic to the cornea (proparacaine). 

• Remove corneal foreign body with a moistened cotton tipped applicator if possible.  

• If this does not eliminate the foreign body then a foreign body spud or 25 gauge needle can be used with caution. 

• Rust rings that are deep or a rust ring that spares the central cornea may be left alone. 

• Treat as corneal abrasion. 

Prognosis:

If simple foreign body of the cornea then healing should occur within 24-48 hours with conservative therapy.   

If an intraocular foreign body is present the prognosis becomes graver from time of injury to time of treatment.   Intraocular foreign bodies need to be transported to a facility where there is a retinal specialist

This section provided by CAPT Robert B. North, Jr., MC, USN

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