Corneal Foreign Body

• Frequently occurs during grinding and drilling steel without wearing protective goggles.

Clinical Features

• Symptoms: foreign body sensation, continuous irritation or ocular pain.
• Signs:
  • Variety of objects may accidentally be lodged superficially or embedded deep within the cornea
  • Vertical corneal abrasions give clues about upper tarsal embedded foreign bodies
  • Metallic foreign bodies often leave rust rings in the surrounding cornea.

Management

• Careful examination of the entire eye to rule out intraocular foreign bodies.
• CT-scanning or MRI (contraindicated when metallic foreign body is suspected).
• Superficial foreign bodies may simply be removed at the slit lamp after instillation of a topical anesthetic using a moist cotton-tipped applicator of fine gauge needle.
• Irrigation is occasionally done to dislodge multiple particles or small fragments.
• Superior tarsal conjunctiva has to be carefully examined, as it is a common location for a hidden foreign body.
• Deeply embedded foreign bodies may be removed with forceps.
• If perforation is suspected, the removal should be done in the OR.
• Every foreign body should be removed unless removal may cause greater damage than allowing it to stay undisturbed.

Medical Therapy

• Topical antibiotics after foreign body removal.
• Topical non-steroidal anti inflammatories such as ketorolac 0.5% and a short acting cycloplegic for marked ocular discomfort or inflammation and for relief of symptoms.