imaging may be warranted . X-ray or CT scans ( see figure 2B ) can provide valuable information regarding |
A |
B |
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the location and extent of the FB . It is |
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important to note that MRI must be |
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avoided when dealing with metallic |
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FBs , as the magnetic field can dislodge |
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the FB and cause collateral damage . |
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Treatment
The steps for FB removal appear in
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box 1 and figure 3 . |
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Management
Post-procedural management
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encompasses pain control , prophylactic |
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antibiotics and follow-up care . Oral paracetamol can be used in conjunction with lubricating eye drops to manage pain . Do not prescribe local anaesthetic as it delays healing and can mask the development of complications such as keratitis . If the patient is uncomfortable , the pupil can be dilated , for exam- |
C |
Figure 2 .
A . Intraocular foreign body from cutting through a metal hook ( arrow shows entry point of metal foreign body ) and hypopyon indicating endophthalmitis .
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ple , with cyclopentolate 1 % to stop ciliary spasm . Regular antibiotic ointment such as chloramphenicol 0.5 % or tobramycin 0.3 % can be |
B . CT scan of orbit showing opaque intraocular foreign body . |
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applied every 3-6 hours for 5-7 days . Firmly apply a double eye pad to prevent eyelid opening and advise the patient to rest , that is , to avoid read- |
C . Extracted intraocular metal foreign body measuring 3mm . |
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ing and using a mobile phone as this |
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moves the eye against the tarsal conjunctiva . Schedule a follow-up |
Box 1 . Removal of a foreign body |
lesions . Enquiring about the patient ’ s work environment and examining |
spasm . Avoid atropine as this has a prolonged effect of up to two weeks . |
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appointment for the next day to reassess visual acuity and the cornea . If there are any signs of infection or progressive inflammation , urgently refer the patient for ophthalmic care .
Prognosis
Superficial and peripheral FBs often resolve without causing longterm vision deficits . Deeper or central FBs have a higher risk of long-term reduction in vision from scarring . Recurrent erosion of the corneal epithelium can occur , especially with organic trauma . These require closer follow-up , with a low threshold for referral to ophthalmic care .
The leading causes of corneal FBs are high-risk activities such
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• The patient can be upright or supine , with their gaze fixed to position the FB for maximum exposure .
• Local anaesthetic ( for example , oxybuprocaine 0.4 % or amethocaine 1.0 %) is used to numb the ocular surface and reduce blepharospasm .
• The eyelids can be held open with clean fingertips or by an assistant with a cotton tip or with an eyelid speculum , if available .
• The technique used will depend on the nature of the FB : — Eyelash – moist cotton tip , fine forceps . — Grass seed – moist cotton tip , No . 15 blade . — Metallic FB – moist cotton tip , No . 15 blade , 25G short needle , burr .
• When using the 25G needle removal technique , mount the needle onto a cotton tip , ensuring the bevel is away from the eye and the needle is moved tangentially to the corneal surface .
• Following removal , irrigate the ocular surface and fornices thoroughly with sterile saline to remove any remaining debris or material .
CORNEAL ABRASION
CORNEAL abrasion , characterised by
and plant material ( see figure 4 ). This may occur during work , recreation or sporting situations .
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everted eyelids can rule out abrasions caused by FBs . When examining the affected eye , blepharospasm can prevent eye assessment , so instil local anaesthetic before examination . Assess the degree of vision whenever possible .
The size and location of the epithelial defect can be demonstrated with fluorescein staining and cobalt blue light . If the pupil is abnormal , for example , dilated or distorted or a hyphaema is present , refer the patient urgently for assessment for suspected intraocular trauma .
Management
Topical antibiotic ointment , such as chloramphenicol 1 % or tobramycin 0.3 % is prescribed q3-6h daily for five days . An uncomplicated epithe-
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Schedule a follow-up appointment for the following day to reassess visual acuity and the cornea . If there are any signs of infection or progressive inflammation , urgently refer the patient for ophthalmic care . Recurrent corneal erosion of the epithelium , especially with organic trauma , can cause longer-term pain .
SHARP TRAUMA
SHARP trauma to the cornea can be
partial thickness or full thickness ( see figure 5 ), determined by the mechanism of the injury . Lower velocity injuries , for example , paper , fingernails or plants can break through the epithelium into the corneal stroma . Higher velocity injuries with harder and sharper objects , such as bird
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as grinding , hammering , drilling , and welding . The promotion of the use of adequate protective eyewear |
disruption of the corneal epithelium , is the most prevalent form of ocular trauma . Common causes include rub- |
History and examination
Corneal abrasion presents with pain ,
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lial defect can heal over 24-48 hours depending on the size of the defect . If the patient is uncomfortable , the |
beaks or metallic blades are more likely to result in perforation . Workplace injuries , motor vehicle accidents |
can reduce the incidence of eye |
bing or poking the eye with a finger or |
photophobia , tearing , itching and |
pupil can be dilated , for example , with |
and assault and battery are common |
injuries . |
FB , for example , sand , contact lenses |
blurred vision , especially for central |
cyclopentolate 1 % to prevent ciliary |
causes of sharp trauma to the cornea . |