Symptoms
Foreign body sensation, tearing, pain, and redness.
Signs
(See Figure 3.3.1.)
Critical
Conjunctival or corneal foreign body with or without a rust ring.
Other
Conjunctival injection, eyelid edema, mild AC reaction, and SPK. A small infiltrate may surround a corneal foreign body; it is usually reactive and sterile. Vertically oriented linear corneal abrasions or SPK may indicate a foreign body under the upper eyelid.
Workup
If there is no evidence of perforation, evert the eyelids and inspect the fornices for additional foreign bodies. Double everting the upper eyelid with a Desmarres eyelid retractor may be necessary. Carefully inspect conjunctival lacerations to rule out an underlying scleral laceration or perforation. Measure and diagram the dimensions of any corneal or scleral infiltrate and the degree of any AC reaction for monitoring therapy response and progression of possible infection.
NOTE: |
There may be multiple foreign bodies with injuries due to power equipment or explosive debris. |
NOTE: |
An infiltrate accompanied by a significant AC reaction, purulent discharge, or extreme conjunctival injection and pain should be cultured to rule out infection, treated aggressively with antibiotics, and followed closely (see 4.11, BACTERIAL KERATITIS). |
Treatment
Corneal Foreign Body (Superficial or Partial Thickness)
NOTE: |
If there is concern for full-thickness corneal foreign body, exploration and removal should be performed in the operating room. |
NOTE: |
Erythromycin ointment should not be used for residual epithelial defects from corneal foreign bodies as it does not provide strong enough antibiotic coverage. |
Conjunctival Foreign Body
Follow Up