Corneal foreign body

Corneal foreign bodies are common. There may be a history of trauma, or using tools (e.g. hammering) without protective goggles or feeling something blow into the eye. Metal foreign bodies can be very adherent and difficult to remove.

Symptoms

  • Foreign body sensation
  • Watering
  • Pain
  • Ask about power tools and consider the possibility of an intraocular foreign body 

Signs

  • Visible corneal foreign body
  • Fluorescein stains the cornea around the foreign body
  • Red eye 

Eye examination

  • Observe conjunctiva and cornea with white light
  • Instil 1 drop of proxymetacaine 0.5% with fluorescein 0.25%
  • Observe for corneal staining preferably using a blue light
  • If the presence of a corneal foreign body is confirmed, moisten a cotton bud with a few drops of sodium chloride 0.9% and gently remove the foreign body with the cotton bud, sweeping it away from the corneal surface; only use a needle to remove if you have been trained and have appropriate magnification
  • Re-examine the eye to ensure the foreign body has been fully removed 

Treatment

  • Give patient foreign body information leaflet
  • Give chloramphenicol ointment QDS 5 days
  • Consider padding and oral analgesia as for corneal abrasion
  • Offer advice e.g. on the wearing of safety glasses, to prevent another injury