Conjunctival/Corneal Foreign Body

Conjunctival/Corneal Foreign Body
SYMPTOMS Eye pain, Eye discomfort, Photophobia, Foreign body sensation, Difficulty opening the eye, Excessive tearing, Decrease in vision especially if foreign body is central
SIGNS Conjunctival foreign body: Foreign deposit noted, Conjunctival injection
Corneal foreign body: Foreign deposit noted, Possible sterile infiltrate due to inflammation from the foreign body, Rust ring if foreign body is metallic (Usually develops 4-6 hours after metallic foreign body goes into cornea), Mild iritis, Mild corneal edema, Conjunctival injection (Typically sectoral adjacent to the foreign body
Foreign bodies in the cornea can be superficial (not involving Bowman’s layer) or Deep (Penetrates through Bowman’s layer but does not rupture Descemet’s layer)
Consider an infectious infiltrate if ulceration is present, if there is a significant iritis, or if the infiltrate is large
Signs of a penetrating foreign body: · Hyphema · Lens opacity · Severe inflammatory response · Irregular/Tear-shaped pupil · Conjunctival or corneal laceration · Shallow anterior chamber · Asymmetric IOPs · Diffuse subconjunctival hemorrhage · Torn iris
WORK-UP Pupils | EOMs | Full eye exam with dilation (Should avoid dilation if there is iris prolapse through the wound, a foreign body in the anterior chamber, or globe rupture)
Anterior segment OCT | Seidel sign | NaFl staining | Lid eversion (Rule out foreign body especially if there are vertical tracks of staining on the cornea)
TREATMENT Conjunctival foreign body: After using a drop of topical anesthetic, remove the foreign body (Usually with a moist cotton tip, spud, jeweler’s forceps, or surgical sponge). Rinse eye with sterile saline after removing foreign body. Start a topical antibiotic (Polytrim 1gtt QID or Moxeza 1gtt BID) until area of foreign body removal heals. Oral NSAIDs may help with pain. Wear eye protection especially if foreign body is work-related
Corneal foreign body: After using a drop of topical anesthetic, remove the foreign body (Usually with a moist cotton tip, spud, jeweler’s forceps, or surgical sponge). If a rust ring is present, remove as much as possible with an Alger brush. Rinse eye with sterile saline after removing foreign body. If excessive or irregular corneal epithelium is present, consider mild debridement as it can impair epithelial growth and healing. Start a topical antibiotic (Polytrim 1gtt QID or Moxeza 1gtt BID) until area of foreign body removal heals. Oral NSAIDs may help with pain. Topical steroids can be considered once the corneal epithelium heals. Consider an amniotic membrane especially if the foreign body is central and there is a risk of scarring. Wear eye protection especially if foreign body is work-related
A lid speculum can be used if patient has difficulty keeping eye open
Refer to ophthalmology if suspecting a penetrating foreign body, corneal perforation, conjunctival perforation, or if the foreign body is in the deep stroma
FOLLOW-UP Monitor 24-48 hours after treatment
ADDITIONAL LAB | TESTS Orbital X-ray or CT (1mm axial and coronal cuts) if suspecting perforation or penetrating foreign body
ETIOLOGY Occurs when a foreign material gets into the eye
Types of foreign bodies: · Metal · Glass · Plastic · Dirt · Insects · Vegetative matter
DIFFERENTIAL DX Corneal ulcer, Corneal abrasion, Corneal laceration, Conjunctival abrasion, Conjunctival laceration
NOTES Foreign bodies composed of vegetative matter have the highest risk of leading to a secondary infection
Involvement of limbal stem cells increases the risk of recurrent epithelial erosion, deep stromal vascularization, and conjunctival overlap
When a rust ring is present, most (if not all) of it should be removed on the first visit in order to allow for better corneal healing and prevention of further inflammation. Minimal rust left over should dissipate over time
Diabetics with foreign body removal tend to heal more slowly
Glass foreign bodies are inert and tend not to cause an inflammatory response (Consider leaving alone especially if glass foreign body is deep)
Posted in Ocular Conditions, Trauma