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Ocular foreign bodies (Intra-ocular (Diagnosis (History Mechanism of…
Ocular foreign bodies
Intra-ocular
Clinical presentation
Mild-moderate pain
Vision may be OK
Diagnosis
History
Mechanism of injury
Type/toxicity of object
Examination
May see entry site
Investigations
USS orbit/X-ray head
Pathophysiology
High velocity object
Inert e.g. gold, platinum, silver, glass, plastic, stone
Toxic - Fe, Cu, thorns/twigs/wood, soil, hair
Management
Conservative
Refer to ophthalmology
Medical
Systemic abx e.g. ciprofloxacin
Surgical
Vitro-retinal surgery
Extra-ocular
Conjunctiva
Pathophysiology
Often dust or grit by the wind
Usually gravitates to lower fornix, may remain
stuck under upper eyelid (subtarsal FB)
Clinical presentation
Pain
Pain on blinking (if stuck)
Management
Remove with cotton bud
Medical
Topical abx e.g. chloramphenicol, fusidic acid
if subtarsal FB with corneal abstrasion
Conservative
Evert eyelid, remove with cotton bud
Diagnosis
Examination
Conjunctival injection
Visible FB
Investigations
Flourescein stain if subtarsal FB injury
(ice rink pattern of vertical corneal abrasions)
History
Mechanism of injury
Cornea
Abrasion
Clinical presentation
Pain/irritation
Watery eye
Photophobia
Blurred vision
Diagnosis
History
HPC: mechanism
Examination
Conjunctival injection
Miosis if marked photophobia
Check if FB present
Investigations
Fluorescein stain (loss of epithelium stains green)
Management
Conservative
No driving until vision returned
Padding of eye?
Review at 1-2d
Medical
Oral analgesia
Topical abx e.g. chloramphenicol
Topical cyclopentolate (dilate pupil, prevents ciliary spasm)
Pathophysiology
Loss of corneal epithelium from foreign object
Trauma e.g. fingernail, FB
Foreign body
Pathophysiology
FB embedded in epithelium/stroma
Metal, vegetation, dusts, domestic, chance
High velocity injury may penetrate globe
Matals can rust, causing scarring and irritation
Clinical presentation
Red watery eye
FB sensation in eye
Complications
Keratitis (rare)
Diagnosis
Examination
Red eye, watery
Visible FB (if none, think globe penetration)
Investigations
USS orbit/CT head (exclude IO FB)
History
Mechanism of injury
Management
Conservative
Instill LA and remove with cotton bud
Remove with blunt (23G) needle from side
Medical
Topical abx e.g. chloramphenicol
Surgery
Indication: large, deep, incompletely
removed FB, rust ring
MOA: surgical exploration and removal