Corneal foreign body

Background

• Must rule-out intraocular foreign body and corneal laceration

Clinical Features

A small piece of iron lodged near corneal margin.

• 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
    • Ocular compartment syndrome
  • Traumatic hyphema
  • Traumatic iritis
  • Traumatic mydriasis
  • Traumatic optic neuropathy
  • Vitreous detachment
  • Vitreous hemorrhage
  • Ultraviolet keratitis

^Emergent diagnoses
^^Critical diagnoses

Evaluation

• 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 follow up in 48h for routine cases
• Ophtho follow up in 24h for rust ring removal

See Also

• Ocular foreign body
• Corneal abrasion
• Eye Algorithms (Main)
• Corneal Ulcer
• Conjunctival Abrasion
• Foreign bodies