Corneal foreign body
Revision as of 17:17, 8 July 2016 by Neil.m.young (talk | contribs) (Text replacement - "==Treatment==" to "==Management==")
Background
- Must rule-out intraocular foreign body and corneal laceration
Clinical Features
- Foreign body sensation
- Photophobia (+/- consensual)
- Decreased vision
- Relief of pain with topical anesthesia
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
- 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
Management
Foreign Body Removal
- Anesthetize eye
- Irrigate with NS
- Moistened cotton swab
- 25G needle
- 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
- Ophtho f/u in 48h for routine cases
- Ophtho f/u in 24h for rust ring removal