Eye Foreign Body Removal

To remove external foreign bodies (FBs) in the eye

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

CONTRAINDICATIONS

Caution 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

General Basic Steps

Preparation

Inspection

Stain

Slit lamp examination

Removal of FB

TECHNIQUE

Patient Preparation

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

In case of intense blepharospasm, administer an ipsilateral facial block

Inspection—FIGURE 85.2

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

Carefully examine behind both eyelids

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

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

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.)

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.)

Fluorescein Stain

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

Inspect 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.

Positive Fluorescein Stain (FIGURE 85.3)

Slit Lamp Inspection

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

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

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

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

Irregular pupil

Shallow anterior chamber

Collapsed iris

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

Hyphema

Lens opacification

Decreased intraocular pressure

FOREIGN BODY VISIBLE

Swab

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

Irrigation

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

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

Embedded FB

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

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. http://www.aafp.org/afp/2004/0701/p123.html. Accessed March 30, 2014.)

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