Foreign body in the eye(s)


## Basic introduction

  • Foreign bodies (FBs) can adhere loosely to or can be embedded in cornea or other parts of the eye
  • FBs can either be non-penetrating superficial or penetrating
  • Non-penetrating superficial FBs are blown or fall into the eyes and they generally do not have serious consequence
  • This constitutes the most common injury to the eye
  • Penetrating FBs are mainly particles, such as metallic chips, that are moving at high velocity penetrating the cornea or sclera. They can cause partial or total loss of vision

## Effect of the presence FBs in the eye(s)

  • Pain
  • Infections
  • Conjunctivitis (due to constant irritation)
  • Endophthalmitis (infection and inflammation inside the eye)
  • Scaring of cornea
  • Ocular necrosis
  • Partial or total loss of vision
  • Early cataract
  • Siderosis in case of iron particles
  • Damage of retina
  • Hemorrhage in the eye
  • Sensation of the presence of foreign body in the eye (that often gets worse upon blinking)
  • Pain
  • Lacrimation
  • Photophobia
  • Redness
  • Vitreous leakage (in case of serious damage)
  • Clinical review including examination of the eyes with and without fluorescein stain application and test of visual acuity
  • Remember to turn the eyelids outwards to rule out the possibility of FBs that are lounged on the underside of the eyelids
  • Do not be complacent after finding one particle - there could be many more!
  • In case of suspicion of the presence of FBs in the eye that are not easily visible, X-ray or CT scan can be carried out.
  • Bacterial Keratitis
  • Fungal Keratitis
  • Corneal ulcer
  • Conjunctivitis (viral, bacterial, allergic etc.)
  • Abrasion
  • Sudden visual loss
  • Trichiasis
  • Ectropion
  • Dry eyes
  • Angle-closure glaucoma
  • Chemical trauma
  • Non-traumatic subconjunctival haemorrhage
  • Use of protective goggles or glasses when handling tasks such as welding and sand harvesting

1. Parver, L. M., Dannenberg, A. L., Blacklow, B., Fowler, C. J., Brechner, R. J., & Tielsch, J. M. (1993). Characteristics and causes of penetrating eye injuries reported to the National Eye Trauma System Registry, 1985-91. Public Health Reports, 108(5), 625.

2. Kenyan Ministry of Health. Clinical guidelines for management and referral of common conditions at levels 4-6. Hospitals. 2009; 3:259-261.

3. Ministry of Health, Kenya. Kenya Essential Medicine List (2016).

4. de Juan, E., Sternberg, P., & Michels, R. G. (1983). Penetrating ocular injuries: types of injuries and visual results. Ophthalmology, 90(11), 1318-1322.


## Non-penetrating superficial FBs

  • First-Aid involves rinsing the eye with water (preferably eye bath or warm water where available)
  • Advise patients never to try removing the FBs with poking objects such as ear buds
  • Apply ophthalmic local anesthetic drops (occasionally) and remove FBs using a cotton bud pre-soaked in normal saline. Sometimes, a special needle may be required.

## Penetrating FBs

  • Vitrectomy
  • Drainage of hemorrhage
  • Removal of damaged lens
  • If the suspected FB is of plant origin or it is contaminated with soil administer the following antibiotic cover:

_Intravitreal vancomycin 1 mg/0.1 ml PLUS ceftazidime 2.27mg/0.1 ml

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