Talk:Removal of Corneal Foreign Bodies

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Corneal Foreign Body Removal by Dr Linda Kaplan

Introduction

The window to the eye, the cornea, is commonly exposed to foreign bodies. Should the eyelids fail to protect the eye, a foreign body that is not spontaneously blinked out should be removed with extreme caution.

Particles such as glass, metal, sand, plastic, vegetable matter or wood may become embedded in the corneal surface from activities including work, hobby or play. Foreign bodies should be removed by an Ophthalmologist to prevent eye infection, internal eye inflammation, and to prevent central corneal scar tissue. If left unattended, a foreign body may get pushed deeper into the cornea. If a foreign body does not penetrate the cornea at inception, rarely will it progress to penetration unless additional force is exerted.

When a foreign body is internal within the eye, it is referred to as an intraocular foreign body (IOFB). Depending on the type and nature of the foreign body, the presence of an IOFB can render the eye blind and painful if not surgically removed appropriately and timely. IOFB removal is a common surgical procedure, wherein utmost care is taken to avoid further damage. If not removed timely, other internal eye tissues may be adversely affected resulting in glaucoma, synechia (internal scar tissue), iritis, uveitis (inflammation), cataract formation, endophthalmitis (infection of the deeper eye tissues) or retinal detachment.

Treatment

After thorough examination by an Ophthalmologist, the eye is anesthetized with topical eye drops to minimize additional pain or discomfort for the patient. Very gently the upper and lower eyelids are separated and held against the orbital rim to widen the aperture and immobilize the eyelids.

Using a Slit Lamp Bio-microscope, the Ophthalmologist may loosen the foreign body with a sharp needle. One has to be extremely careful to not penetrate through the cornea. With the foreign body loosened up, appropriate forceps are used to gently remove the foreign body particle or fragments from the eye. If there is a residual rust ring (from an iron foreign body), it should be removed with an Alger Burr.

Post Treatment

The removal of a foreign body often leaves a divet in the corneal surface called an erosion. Depending on the size and depth of the erosion, there are options for treatment.

Applying antibiotic eye ointment and an eye patch for 24 hours is most common. Caution is taken to immobilize the eyelids closed with the pressure patch.

In the event, the erosion is non healing, a bandage contact lens may be inserted. This serves two purposes. A bandage lens allows the patient to have some vision while it negates the deleterious impact of the eyelid blink. The blink of an eyelid can dislodge fresh corneal epithelial cells that have migrated into the erosion to heal the cornea. If your Ophthalmologist places a bandage contact lens for vision and protection, it must be monitored. The bandage lens itself can become a nidus for infection and create a deleterious effect. As such, antibiotic eye drops may be added prophylactically.

Once the bandage lens is removed and the erosion is healed, your Ophthalmologist may elect to treat the cornea with hypertonic medications to prevent recurrent corneal erosions.