10 Anterior Foreign Bodies

Foreign Bodies

Various particles comprised of either inert/organic material which can inappropriately adhere to eye and/or lodge internally

Superficial FB can be located…

Sub-tarsal or corneal

Superficial sub-tarsal FB

Small particle that gets most commonly trapped under upper eyelid w/ resultant rub against ocular surface (dust/dirt particles, wood splinters, metal fragments, or shavings from grinding)

Superficial corneal FB

Particle that is stuck on surface/embedded in cornea (small metallic shavings, wood splinters, glass shards)

Intraocular FB

Object which has ability to penetrate into eye (most commonly referencing penetration into anterior and/or posterior chamber)

Double eversion

Advanced medical technique which turns on eyelid inside out twice, exposing the deep recess (superior conjunctival fornix)

Seidel test

Medical procedure used to identify full-thickness defects in the cornea or sclera by revealing leakage of aqueous humor

Positive Seidel Test

• bright green stream/waterfall which flows away from wound w/ gravity (aqueous leak)

• Necessitates immediate management of ophthalmology to help in preserving vision & preventing downstream complications

Negative Seidel Test

Uniform, concentrated dye that is not diluted/streaming

Sub-tarsal inert FB tx/management

• in-office removal

• Saline irrigation > multiple/loose foreign bodies

• Cotton-tipped applicator soaked in topical anesthetic > cases w/ poor adherence

• Fine forceps > cases w/ firm adherence

Post-removal medical considerations for sub-tarsal inert FB

• topical antibiotic

  • Bacitracin ung BID-QID

  • Trimethoprim/polymyxin B (polytrim) QID

  • Fluoroquinolone QID

• PFAT prn (help reduce irritation)

Corneal inert FB tx/management

in office removal

• under topical anesthesia

• Remove FB w/ foreign body spud, fine forceps, small-gauge needle

• Remove associated rust ring w/ small gauge needle

Measure size of resultant epithelial defect & remember to document in medical record

Tx/management of corneal inert FB (non CL wear)

• topical antibiotic

  • Bacitracin ung BID-QID

  • Trimethoprim/polymyxin B (polytrim) QID

  • Fluroquinolone QID

  • Cyclopentalate 1% BID-TID (considered in cases of pain, secondary iritis)

• Bandage CL in cases of large epithelial defects, significant pain, poor healing in absence of infection; need to RX concomitant antibiotic

Tx/management for corneal inert FB (CL wearer)

• topical antibiotic

  • Fluroquinolone QID

  • Need Pseudomonas coverage

  • Cyclopentolate 1% BID-TID (considered in cases of pain, secondary iritis)

F/U for subtarsal conjunctival FB

As needed

F/U for corneal FB (non-CL wearer)

• bandage CL > q24 hrs (follow closely)

• Residual rust rink remains > q24hr

• Central/large defect > initial q24 hr, improvement 2-3 days until resolved

• Peripheral/small defect > initial q2-3 days, improvement 3-5 days until resolved

F/U for corneal FB (CL wearers)

• close F/U until epithelial defect resolves

• Continue tx w/ antibiotic 1-2 days following resolution

• CL wear resumed 1 wk after resolution