Foreign body in the eye(s)

Notes

## 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
Symptoms
  • 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)
Diagnosis
  • 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.
Differential
  • 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
Prevention
  • Use of protective goggles or glasses when handling tasks such as welding and sand harvesting
Reference

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.http://apps.who.int/medicinedocs/documents/s21000en/s21000en.pdf

3. Ministry of Health, Kenya. Kenya Essential Medicine List (2016). http://publications.universalhealth2030.org/uploads/KEML-2016Final-1.pdf

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

Management

## 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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