These are pictures of Corneal Foreign Body. This is a part in OPHTHALMIC TRAUMA of the Atlas of Emergency Medicine book
Clinical Summary
Patients typically report getting something in the eye or complain of FB sensation. FBs that overlie the cornea may affect vision. Tearing, conjunctival injection, headache, and photophobia may also be present. The most important consideration is the possibility of a penetrating globe injury. One must elicit a meticulous history about the mechanism of injury.
Management and Disposition
Topical anesthetic drops (eg, 0.5% proparacaine or tetracaine) facilitate examination and removal. If superficial, removal with saline flush may be attempted before using a sterile eye spud or small (25-gauge) needle. Consider topical antibiotic drops or ointment for the residual corneal abrasion. Tetanus prophylaxis is indicated. A “short-acting” cycloplegic (eg, cyclopentolate 1% or homatropine 5%) may benefit patients with headache or photophobia. FB or “rust ring” removal should be conducted using slit-lamp microscopy, only by a physician skilled in rust ring removal due to the risk of corneal perforation or scarring.
Pearls
1. Always evert the upper lid and search carefully for an FB. An FB adherent to the upper lid abrades the cornea, producing the “ice-rink” sign, caused from multiple linear abrasions.
2. Vigorous attempts to remove the entire rust ring are not warranted. This may await emergency department or ophthalmology follow-up in 24 hours.
3. Use of cotton-tipped applicators to attempt FB removal should be discouraged (large surface area and potential to cause a larger corneal defect).
FIGURE 4.10 ■ “Rust Ring.” A rust ring has formed from a foreign body
(likely metallic) in this patient. A burr drill can be used for attempted removal,
which, if unsuccessful, can be reattempted in 24 hours.
FIGURE 4.11 ■ Foreign Body on the Cornea. A small foreign body is lodged
at 4-o’clock position on the cornea.
REFERENCES
The Atlas of Emergency Medicine, Fourth Edition, 2016.
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