Ocular foreign body
Background
Ocular foreign bodies are a high-risk chief complaint because of short and long-term threats to vision loss. The main goal is to determine superficial vs. intraocular foreign bodies.
Clinical Features
- Patient history with focus on circumstances/mechanism of symptom onset
- e.g. use of power tools, projectile weapons, MVCs, metal-on-metal impacts, or high-impact trauma
- Most common is metal foreign body from hammering
- Ocular foreign bodies may be superficial or intraocular
- Superficial: embedded in conjunctiva or cornea
- Eye pain
- Foreign body sensation
- Tearing
- Blurry Vision
- Intraocular penetration may be asymptomatic initially and present after complications arise (e.g. corneal ulcer)
- Superficial: embedded in conjunctiva or cornea
- Must be careful of multiple foreign bodies
Physical Exam
- Gross ocular inspection
- Determine open-globe injury e.g. prolapsed intraocular structures, irregular shaped pupil
- Visual acuity test
- Slit lamp exam with and without fluorescein
- Document size, depth, and location of corneal foreign bodies
- Signs of deep injury:
- Inflammation or hemorrhage of anterior chamber
- Corneal or scleral wounds
- Corneal infiltrate or hypopyon
- Iris transillumination
- Lens opacities
- Seidel test
- Evert lids to check for subtarsal foreign bodies
- Indicated by linear corneal abrasions
Differential Diagnosis
Unilateral red eye
- Nontraumatic
- Acute angle-closure glaucoma^
- Anterior uveitis
- Conjunctivitis
- Corneal erosion
- Corneal ulcer^
- Endophthalmitis^
- Episcleritis
- Herpes zoster ophthalmicus
- Inflamed pinguecula
- Inflamed pterygium
- Keratoconjunctivitis
- Keratoconus
- Nontraumatic iritis
- Scleritis^
- Subconjunctival hemorrhage
- Orbital trauma
- Caustic keratoconjunctivitis^^
- Corneal abrasion, Corneal laceration
- Conjunctival hemorrhage
- Conjunctival laceration
- Globe rupture^
- Hemorrhagic chemosis
- Lens dislocation
- Ocular foreign body
- Posterior vitreous detachment
- Retinal detachment
- Retrobulbar hemorrhage
- Traumatic hyphema
- Traumatic iritis
- Traumatic mydriasis
- Traumatic optic neuropathy
- Vitreous detachment
- Vitreous hemorrhage
- Ultraviolet keratitis
^Emergent diagnoses ^^Critical diagnoses
Diagnosis
Work-up
Evaluation
Management
- ED removal for small superficial objects
- Ophthalmology consult for surgical removal emergently for deeply penetrating or larger objects
Antibiotics
Boad-spectrum intravenous therapy prior to surgery
- Moxifloxacin
- Has the best intraocular penetration
Disposition
- Admission and emergent surgical intervention with Ophthalmology for removal