What is the appropriate management for a patient with a foreign body in the eye?

From the Guidelines

The step-by-step eye exam for a foreign body should include visualization attempt, fluorescein staining, inspection under the lid, and sweep of the lid to ensure thorough evaluation and removal of the foreign body, as recommended by the most recent guidelines 1. The examination process begins with a thorough visualization attempt to locate the foreign body, which may involve the use of a slit lamp or other specialized equipment.

• The next step is to perform fluorescein staining to help identify any corneal abrasions or defects that may be associated with the foreign body, as described in the bacterial keratitis preferred practice pattern 1.
• Inspection under the lid is also crucial, as foreign bodies can sometimes become lodged under the eyelid, and a sweep of the lid may be necessary to remove the object.
• The use of topical anesthetic drops, such as proparacaine 0.5% or tetracaine 0.5%, can help minimize discomfort during the examination and removal process, as suggested by general medical practice. Key considerations during the examination include:
• The location and depth of the foreign body
• The presence of any corneal abrasions or defects
• The potential for infection or other complications
• The need for referral to an ophthalmologist for further evaluation and treatment, as recommended by the American Heart Association and American Red Cross guidelines for first aid 1.

From the FDA Drug Label

INDICATIONS AND USAGE: Proparacaine hydrochloride ophthalmic solution is indicated for topical anesthesia in ophthalmic practice. Representative ophthalmic procedures in which the preparation provides good local anesthesia include measurement of intraocular pressure (tonometry), removal of foreign bodies and sutures from the cornea, conjunctival scraping in diagnosis and gonioscopic examination; it is also indicated for use as a topical anesthetic prior to surgical operations such as cataract extraction. DOSAGE AND ADMINISTRATION: Deep anesthesia as in cataract extraction: Instill 1 drop every 5 to 10 minutes for 5 to 7 doses. Removal of sutures: Instill 1 or 2 drops 2 or 3 minutes before removal of stitches. Removal of foreign bodies: Instill 1 or 2 drops prior to operating. Tonometry: Instill 1 or 2 drops immediately before measurement FOR OPHTHALMIC USE ONLY

The step by step eye exam for foreign body includes:

• Visualization attempt: No specific details are provided in the drug label.
• Fluorescein staining: No specific details are provided in the drug label.
• Inspection under the lid: No specific details are provided in the drug label.
• Sweep of lid: No specific details are provided in the drug label. However, the drug label does mention removal of foreign bodies as an indication for the use of proparacaine hydrochloride ophthalmic solution 2, and the administration of 1 or 2 drops prior to operating for removal of foreign bodies 2.

From the Research

Step-by-Step Eye Exam for Foreign Body

• Visualization Attempt: The first step in managing a patient with a foreign body in the eye is to attempt to visualize the foreign body 3, 4, 5.
• Fluorescein Staining: After the visualization attempt, fluorescein staining of the cornea should be performed to help identify the foreign body and any potential corneal abrasions 3, 5.
• Inspection Under the Lid: The next step is to inspect under the lid to check for any foreign bodies that may be lodged there 4.
• Sweep of Lid: A sweep of the lid should be performed to remove any foreign bodies that may be present 4.

Additional Considerations

• A thorough examination of both eyes should be performed to rule out any other potential injuries or conditions 4, 5.
• The patient's history and physical examination should exclude serious causes of eye pain, including penetrating injury, infective keratitis, and corneal ulcers 3.
• Topical antibiotics may be prescribed to prevent bacterial superinfection, especially in cases of contact lens-related abrasions 3.
• Follow-up may be necessary to ensure that the patient's symptoms are resolving and that no further treatment is needed 3.