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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