Corneal foreign body

Background

• Must rule-out intraocular foreign body and corneal laceration

Clinical Features

1. Foreign body sensation
2. Photophobia (+/- consensual)
3. Decreased vision
4. Relief of pain with topical anesthesia

Diagnosis

• Evaulate for penetrating injury
• Should have negative Seidel sign (no streaming of fluorescein out of eye)
• Intraocular foreign body?
  • If concern for foreign body but none visualized on external exam consider CT orbit

Differential Diagnosis

1. Corneal Ulcer
2. Herpes Zoster Ophthalmicus
3. Corneal laceration
4. Intra-ocular foreign body

Treatment

Foreign Body Removal

1. Anesthetize eye
   1. Irrigate with NS
2. Moistened cotton swab
3. 25G needle
   1. Approach from tangential angle

Rust Rings

• Not necessary to remove in the ED; refer to ophtho for definitive removal

Prophylactic Antibiotics

Does Not Wear Contact Lens

• Erythromycin ointment qid x 3-5d OR
• Ciprofloxacin 0.3% ophthalmic solution 2 drops q6 hours OR
• Ofloxacin 0.3% solution 2 drops q6 hours OR
• Sulfacetamide 10% ophthalmic ointment q6 hours

Wears Contact Lens

Antibiotics should cover pseudomonas and favor 3rd or 4th generation fluoroquinolones

• Levofloxacin 0.5% solution 2 drops ever 2 hours for 2 days THEN q6hrs for 5 days OR
• Moxifloxacin 0.5% solution 2 drops every 2 hours for 2 days THEN q6hrs for 5 days OR
• Tobramycin 0.3% solution 2 drops q6hrs for 5 days OR
• Gatifloxacin 0.5% solution 2 drops every 2 hours for 2 days THEN q6hrs for 5 days OR
• Gentamicin 0.3% solution 2 drops six times for 5 days

Disposition

1. Ophtho f/u in 48h for routine cases
2. Ophtho f/u in 24h for rust ring removal

See Also

• Corneal abrasion
• Eye Algorithms (Main)
• Corneal Ulcer
• Conjunctival Abrasion