Corneal foreign bodies are common. There may be a history of trauma, or using tools (e.g. hammering) without protective goggles or feeling something blow into the eye. Metal foreign bodies can be very adherent and difficult to remove.
Symptoms
- Foreign body sensation
- Watering
- Pain
- Ask about power tools and consider the possibility of an intraocular foreign body
Signs
- Visible corneal foreign body
- Fluorescein stains the cornea around the foreign body
- Red eye
Eye examination
- Observe conjunctiva and cornea with white light
- Instil 1 drop of proxymetacaine 0.5% with fluorescein 0.25%
- Observe for corneal staining preferably using a blue light
- If the presence of a corneal foreign body is confirmed, moisten a cotton bud with a few drops of sodium chloride 0.9% and gently remove the foreign body with the cotton bud, sweeping it away from the corneal surface; only use a needle to remove if you have been trained and have appropriate magnification
- Re-examine the eye to ensure the foreign body has been fully removed
Treatment
- Give patient foreign body information leaflet
- Give chloramphenicol ointment QDS 5 days
- Consider padding and oral analgesia as for corneal abrasion
- Offer advice e.g. on the wearing of safety glasses, to prevent another injury