Foreign body in the eye

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Foreign bodies refer to specks of dust, small insects or other tiny objects that get into the eyes. The foreign body may be either in the conjunctival sac, on the cornea or  inside the eyeball (intraocular). A history of the likely nature of the foreign body aids in its detection and removal. The foreign body may be seen by careful inspection of the cornea or conjunctival sac. Adequate lighting is needed to detect corneal foreign bodies.

Cause

  • Specks of dust
  • Small insects
  • Ferrous metallic specs (such as occurs with metal grinders)
  • Other tiny objects

Symptoms

  • Feeling of something in the eye which may be irritating
  • Sudden discomfort or severe pain
  • Watering of the eye
  • Red eye(s)
  • Photophobia i.e. intolerance to light
  • Inability to open the eye

Signs

  • Evidence of foreign body
  • Conjunctivitis
  • Tearing of the eyes
  • Photophobia
  • Chemosis 
  • Sub-conjunctival haemorrhage
  • Irregular pupil in penetrating eye injury with retained intraocular foreign body
  • Blood in the anterior chamber (hyphaema)

Investigations

  • X-ray of the orbit (suspected metallic foreign body)

TreatmentTreatment Objectives

  • To remove superficial foreign bodies
  • To treat associated injury
  • To prevent complications

Non-pharmacological treatment

  • Where the foreign body is under the upper eyelid, evert the eyelid and remove the foreign body.
  • If the foreign body cannot be removed, apply topical antibiotic, pad the eye and REFER to an eye specialist clinic.

Pharmacological treatment 

Foreign body identification

  • Tetracaine hydrochloride, 0.5% eye drop, Instill one or two drops prior to evaluation 

For eye irrigation

  • Normal Saline, 0.9%,

Prevention of infection

1st Line Treatment

Evidence Rating: [C]

  • Chloramphenicol eye ointment, 1% topical, (After removal of foreign body)

Pain control

  • Paracetamol, oral,

Adults

500 mg-1 g 6 -8 hourly as required 

Children

6-12 years; 250-500 mg 6-8 hourly as required

1-5 years; 120-250 mg 6-8 hourly as required 

3 months -1 year; 60-120 mg 6-8 hourly as required

Referral Criteria

  • Refer patients with corneal foreign bodies, intraocular foreign bodies, persistent pain and redness of the eye to the eye specialist.