Ocular foreign body: Difference between revisions
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==Management==
==Management==
*[[Tetanus]] booster as needed
*Pain control with topical [[NSAIDs]] (e.g. [[diclofenac]] or [[ketorolac]]) or oral [[opioids]]
===Superficial ocular foreign body with no signs of open globe injury===
===Superficial ocular foreign body with no signs of open globe injury===
*Conjunctival foreign body
*Conjunctival foreign body
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***Copious irrigation
***Copious irrigation
***Cotton-tipped swab soaked in saline
***Cotton-tipped swab soaked in saline
**Pain control with topical [[NSAIDs]] (e.g. [[diclofenac]] or [[ketorolac]]) or oral [[opioids]]
**Consider [[Cycloplegics]] (e.g. [[cyclopentolate]] or [[homatropine]]) for photophobia
**[[Tetanus]] booster as needed
**Consider topical antibiotics for corneal involvement
*[[Corneal foreign body]]
*[[Corneal foreign body]]
**30- to 25-gauge needle under [[slit lamp]]
**30- to 25-gauge needle under [[slit lamp]]
**Repeat Seidel test to ensure removal did not perforate cornea
**Repeat Seidel test to ensure removal did not perforate cornea
**Irrigate eye profusely post-removal
**Irrigate eye profusely post-removal
*Pain control with topical [[NSAIDs]] (e.g. [[diclofenac]] or [[ketorolac]]) or oral [[opioids]]
**[[Cycloplegics]] (e.g. [[cyclopentolate]] or [[homatropine]]) for photophobia
*[[Cycloplegics]] (e.g. [[cyclopentolate]] or [[homatropine]]) for photophobia
**Consider topical antibiotics for corneal involvement
***Target gram-positive + pseudomonas (contact wearers)
***[[Moxifloxacin]] – best ophthalmologic penetration
 


*Consider topical antibiotics for corneal involvement
*Rust ring
**Target gram-positive + pseudomonas (contact wearers)
**Not a true emergency as many will wash out spontaneously
**[[Moxifloxacin]] – best ophthalmologic penetration
**May be removed with a 30- to 25-gauge needle as above
*Schedule follow-up with ophthalmologist


===Intraocular foreign bodies or concern for open globe injury===
===Intraocular foreign bodies or concern for open globe injury===
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*Placement of rigid eye shield
*Placement of rigid eye shield
*Analgesia (oral [[NSAIDS]] or [[opioids]]) and [[antiemetics]] as necessary
*Analgesia (oral [[NSAIDS]] or [[opioids]]) and [[antiemetics]] as necessary
===Rust rings===
*Not a true emergency as many will wash out spontaneously
*May be removed with a 30- to 25-gauge needle as above


==Disposition==
==Disposition==

Revision as of 12:24, 30 March 2017

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.
  • Always consider possibility of multiple 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

Superficial (embedded in conjunctiva or cornea)

  • Eye pain
  • Foreign body sensation
  • Tearing
  • Blurry Vision

Intraocular

  • As above, although may additionally be asymptomatic initially and present after complications arise (e.g. corneal ulcer)
  • +Sidel's sign

Differential Diagnosis

Orbital trauma

Acute

Subacute/Delayed

Unilateral red eye

^Emergent diagnoses ^^Critical diagnoses

Evaluation

Based on patient mechanism/history

  • Possible high impact metal (e.g. hammering, use power tools, projectile weapons, metal-on-metal impacts, or high-impact trauma)
    • Eye exam
      • Slit lamp exam with fluorescein
      • Intraocular pressure
      • Extensive ocular exam with lid eversion or sweep to check for subtarsal foreign bodies
    • CT orbit
  • Non-high impact metal history (vegetation, dirt, dust)
    • Eye exam only
      • Slit lamp exam with fluorescein
      • Intraocular pressure
      • Extensive ocular exam with lid eversion or sweep to check for subtarsal foreign bodies

Contraindicated

Management

Superficial ocular foreign body with no signs of open globe injury

  • Conjunctival foreign body
    • ED removal after topical anesthetic
      • Copious irrigation
      • Cotton-tipped swab soaked in saline
  • Corneal foreign body
    • 30- to 25-gauge needle under slit lamp
    • Repeat Seidel test to ensure removal did not perforate cornea
    • Irrigate eye profusely post-removal
    • Cycloplegics (e.g. cyclopentolate or homatropine) for photophobia
    • Consider topical antibiotics for corneal involvement
      • Target gram-positive + pseudomonas (contact wearers)
      • Moxifloxacin – best ophthalmologic penetration


  • Rust ring
    • Not a true emergency as many will wash out spontaneously
    • May be removed with a 30- to 25-gauge needle as above

Intraocular foreign bodies or concern for open globe injury

Disposition

Outpatient

  • Superficial ocular foreign body after removal

Admission

  • With emergent surgical intervention for:

See Also

External Links

References

  1. ↑ Babineau MR, Sanchez LD, Ophthalmologic procedures in the emergency department Emerg Med Clin Am 2008 26.1:17-34.
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