Be an Ocular Foreign Body Fixer

Foreign bodies lodged here can be removed using a variety of instruments, including a small-gauge disposable needle, a foreign body spud or a loop. Sterile disposable needles come in a variety of diameters (gauges) and lengths—the 25-gauge 5/8-inch size needle is popular for corneal foreign body removal due to its short length and minimal flexure.

 Eye Health: A Foreign Body in the Eye

Few disagree with the discomfort, irritation, and, in some cases, severe pain and fear they feel when they get something stuck in their eye. From a dust particle to a metal shard, this type of injury takes many forms. Known in the medical community as a "foreign body" (in the eye)...and with our eyes as our portals to the world, well, we just don't want stuff stuck in them!

 Eye irrigation as a first-line treatment and diagnostic method for emergency department patients who complain of ocular foreign bodies

External eye irrigation is a standard protocol in the ED for treating ocular chemical injuries. In our ED, after excluding open-globe injuries, physicians commonly order eye irrigation for patients complaining of ocular FBs. During the ophthalmologic consultations that follow, many patients report that their ocular pain greatly diminished after irrigation, and among such patients, retained FBs are uncommon.

 Foreign Body Removal

Anesthetizing both eyes can be helpful, because that can eliminate reflex blinking during attempts at foreign body removal. Irrigate with normal saline first, as a very superficial foreign body may be irrigated off the cornea. Next, try to dislodge the foreign body with a moistened cotton applicator (Q-tip) If the foreign body is tightly adherent to or embedded in the cornea, inspect the cornea using optic sectioning on the slit lamp to assess the depth of penetration... For superficial foreign bodies, a 25-gauge needle (using needle bevel up) or a sterile foreign body spud (1 mm diameter) on an Alger brush (a low-speed, low-torque, battery-operated hand-held drill) can be used to remove the foreign body.

 Foreign Body Removal Start to Finish

The simplest method to remove loose pieces of material may be using only irrigation with sterile saline solution. If that isn’t sufficient, a sterile cotton swab, spatula, spud or a small 25-gauge needle are all useful options. A magnetic spud is quite useful for metallic foreign bodies because you can often remove the object—and any residual metallic flakes—with little to no damage.

I Feel Something in My Eye; A Retrospective Study on the Outcome of Patients with Corneal Foreign Bodies Presenting to Emergency Department

While closed globe traumas including those caused by EOFBs are less severe than open globe traumas and usually result in better visual outcomes, they still represent a significant disease burden in the ED.

SAEM Clinical Image Series: Corneal Foreign Body

Apply tetracaine anesthetic to the affected eye. Under the slit lamp 10x view and using a thin 25 gauge needle, remove the embedded foreign body.

Simple Foreign Body Removal from the Eye

There are 2 types of foreign bodies you will encounter: (1) nonimpacted ones are simply adhered to eye. These can be easily removed by gently touching a sterile Q-tip to it and slowly roll. DO NOT PRESS HARD since you may drive the object into the eye, which brings us to the second type (2) impacted. These are more difficult to treat and I’m going going to cover the most basic type, small metal ones. Other, larger impacted objects, require an urgent ophthalmology consultation with the very real possibility of losing that eye.

Something in my eye, Doc

Remember to evert the eyelids in the quest for foreign bodies. Don’t fall into the trap of settling for one foreign body — there may be more! Beware of self-sealing lacerations — Seidel test may be helpful but does not rule out corneal lacerations. [Erich Seidel (1882 – 1948)].

Super Glued Shut

The adhesive will attach itself to the eye protein and will disassociate from it over time, usually within several hours. Periods of weeping and double vision may be experienced until clearance is achieved. Use of water to wash eyes repeatedly may assist in aiding more rapid removal of the adhesive.