Corneal Foreign Body

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Examination

  • (Metal) corneal foreign body , rust ring
  • Always ectropionate!
    • vertical scratches: subtarsal foreign body?
  • Examine opposite eye (asymptomatic foreign body?)
  • Signs of intraocular foreign body?
    • Mechanism? (e.g. hammer and chisel injury)
    • Positive Seidel?
    • Lens/iris defects?
    • Anterior chamber depth asymmetric?

Therapy

  • Foreign body removal with swab or insulin needle
  • In case of metal foreign body also remove the rust ring
    • In case of a large rust ring: soften with ointment (bandage) and try to remove it again the next day with insulin needle or drill
    • Try to avoid damage of healthy tissue as much as possible (danger with drill), max. 2 attempts.
  • Prophylactic antibiotic therapy until epithelial closure:
    • Inorganic materials: Tobrex gtt (Tobramycin) 3x/d or Floxal gtt (Ofloxacin) 3x/d
    • Organic materials: Floxal gtt (Ofloxacin) 3x/d, Floxal ointment (Ofloxacin) at night
  • Consider additional lubricating therapy
  • In case of central/paracentral findings, consider steroid therapy for scar modulation (if visual is reduced)
  • Do not use bandage contact lenses

Follow-up

  • Consider removal of residual rust if necessary on the following day
  • In case of peripheral findings and complete removal of the foreign body, follow-up as needed (patients should present again in case of progressive redness, pain or visual loss).

Sources

  • EyeWiki – Removal of Corneal Foreign Bodies
  • The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
  • Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8. Auflage (2015)