Download FB sub-tarsal - Vision 2020 UK

Version 9 (29.12.08)
Name:
CONDITION
Corneal (or other superficial ocular) foreign body
Aetiology
Patient often gives history of foreign body entering eye
- wind blown
- high velocity (hammering, grinding)
DIY and gardening
Predisposing
factors
Lack of suitable eye protection
Symptoms
Irritation/foreign body sensation/pain
Lacrimation
Blurred vision
Red eye
Signs
Foreign body adherent to ocular surface
Linear corneal scratches
Corneal rust ring from ferrous foreign body
Surrounding ring of oedema and infiltrate if longstanding
Subconjunctival haemorrhage may be present
History is important
- high velocity particles – risk of globe penetration
- metallic – rust ring (haemosiderosis)
- vegetative – risk of fungal infection
Recurrent erosion syndrome
Differential
diagnosis
Management by Optometrist
Non-pharmacological
Rule out multiple particles – cornea, conjunctiva (bulbar, fornix,
palpebral): double evert lids
Loose foreign body can be irrigated away with normal saline
Foreign body on conjunctiva can be removed with a cotton bud
Assess depth of corneal foreign body (slit lamp optical section)
Corneal foreign body may require removal with a hypodermic
needle or other disposable instrument. If non-disposable
COMMENTS
Version 9 (29.12.08)
Name:
CONDITION
Corneal (or other superficial ocular) foreign body
instruments are used they must come from a sterile pack
After removal, assess size of remaining epithelial defect so that
healing can be monitored
Check:
- VA before and after FB removal
- globe and adnexae for signs of penetration
- AC for flare or cells
- pupil responses
Do not patch eye (see Evidence Base)
Advise patient to return/seek further help if symptoms persist
Advise patient to wear suitable eye protection in future
COMMENTS
Version 9 (29.12.08)
Name:
CONDITION
Corneal (or other superficial ocular) foreign body
Pharmacological
Remove foreign body under topical anaesthesia (g. benoxinate
0.4% or g. amethocaine 0.5%)
Consider use of ointment (unmedicated or medicated) following
removal (as ocular lubrication)
If there is a likelihood of infection, consider topical antibiotic
prophylaxis (e.g. g. chloramphenicol 0.5% qds for 5 days)
Systemic analgesia if necessary
B3: superficial FB: normally no referral
A2: penetration into stroma, or presence of rust ring, may result
in scarring and potential visual loss, therefore refer
Management
category
Possible management by Ophthalmologist
Exploration of wound (especially if sub-conjunctival
haemorrhage is also present)
Removal of deep foreign body
Use of burr or other instrument to remove rust ring
Evidence base
Turner A, Rabiu M. Patching for corneal abrasion. Cochrane
Database of Systematic Reviews 2006, Issue 2. Art. No.:
CD004764. DOI: 10.1002/14651858.CD004764.pub2
(The trauma to which the authors refer in this review could be
caused by corneal foreign bodies and their removal)
Authors’ conclusions: ‘Treating simple corneal abrasions with a
patch does not improve healing rates on the first day post-injury
and does not reduce pain. In addition, use of patches results in a
loss of binocular vision. Therefore it is recommended that
patches should not be used for simple corneal abrasions.’
(Centre for Evidence-based Medicine Level of Evidence = 1a)
In the absence of other evidence, management based on
COMMENTS
Version 9 (29.12.08)
Name:
CONDITION
Corneal (or other superficial ocular) foreign body
Clinical Consensus
(Centre for Evidence-based Medicine Level of Evidence = 5)
COMMENTS