Eye Foreign Body Removal

imagesTo remove external foreign bodies (FBs) in the eye


imagesSymptoms include pain, redness, increased tearing, or FB sensation


CONTRAINDICATIONS



imagesCaution and care must be taken if globe rupture is suspected especially when the history includes flying particles or high-velocity projectiles


LANDMARKS—FIGURE 85.1




imagesGeneral Basic Steps


   imagesPreparation


   imagesInspection


   imagesStain


   imagesSlit lamp examination


   imagesRemoval of FB


TECHNIQUE



imagesPatient Preparation


   imagesPlace 0.5% tetracaine or 0.5% proparacaine drops in the eye (may use in both eyes to reduce the blink reflex)


   imagesIn case of intense blepharospasm, administer an ipsilateral facial block


imagesInspection—FIGURE 85.2


   imagesExamine the conjunctiva and cornea carefully. Do not assume there will only be one FB.


   imagesCarefully examine behind both eyelids


      imagesLower eyelid: Pull down the lower eyelid and ask the patient to look up


      imagesUpper eyelid: Using a cotton-tipped applicator as a fulcrum, carefully pull the eyelashes down and out to evert the lid



images


FIGURE 85.1 Periorbital structures. (From Knoop KJ, Dennis W. Eye trauma. In: Wolfson AB, ed. Harwood-Nuss’ Clinical Practice of Emergency Medicine. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2015:174, with permission.)



images


FIGURE 85.2 Cross section of the eye. (From Knoop KJ, Dennis W. Eye trauma. In: Wolfson AB, ed. Harwood-Nuss’ Clinical Practice of Emergency Medicine. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2015:175, with permission.)


imagesFluorescein Stain


   imagesGently touch the fluorescein strip to the lower eyelid conjunctiva and ask the patient to blink two to three times. Wipe away the excess.


   imagesInspect the cornea for abrasions (fluorescein when taken up by the alkaline Bowman membrane, will fluoresce with a cobalt-blue light). Patients with corneal abrasions may have FB sensation in the absence of a retained FB.


imagesPositive Fluorescein Stain (FIGURE 85.3)


imagesSlit Lamp Inspection


   imagesExamine the fluorescein-stained cornea under the blue light of a slit lamp


   imagesVertical linear lesions on the cornea should raise suspicion for an FB under the eyelids


   imagesIf you see an FB extending through the full thickness of the cornea, consult an ophthalmologist


   imagesSigns of an intraocular FB may be subtle or absent. Look carefully for the following:


      imagesIrregular pupil


      imagesShallow anterior chamber


      imagesCollapsed iris


      imagesPositive Seidel test (extrusion of fluorescent material from the cornea)


      imagesHyphema


      imagesLens opacification


      imagesDecreased intraocular pressure


FOREIGN BODY VISIBLE



imagesSwab


   imagesIf easily visualized, remove the particle with a moist sterile cotton-tipped applicator or nasopharyngeal swab


imagesIrrigation


   imagesFB may be flushed out when the eye is irrigated gently with a stream from an Angiocath connected to a syringe containing saline


   imagesIf more copious irrigation is required, consider commercial devices such as the Morgan lens


imagesEmbedded FB


   imagesCornea can be gently scraped with a small 25- or 27-gauge needle, attached to a syringe for stability (under the slit lamp)



images


FIGURE 85.3 Corneal abrasion stained with fluorescein under cobalt-blue light. (From Wilson SA, Last A. Management of corneal abrasions. Am Fam Physician. 2004;70(1):123–128. www.aafp.org/afp/2004/0701/p123.html. Accessed March 30, 2014.)

Only gold members can continue reading. Log In or Register to continue

Aug 9, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Eye Foreign Body Removal
Premium Wordpress Themes by UFO Themes