What is the proper procedure for removing a metal foreign body from the eye?

Metal Foreign Body Removal from the Eye: First Aid and Medical Management

For metal foreign bodies in the eye, immediate medical attention should be sought, especially for high-velocity injuries, as attempting self-removal can cause significant damage to the eye and vision. 1

Initial Assessment and First Aid

For Low-Energy Foreign Bodies:

• Do NOT rub the eye under any circumstances 1
• For loose foreign bodies (dust, dirt, eyelash):
  • Allow natural tears to wash out the object
  • Alternatively, irrigate with tap water or commercial eyewash solution 1
• To prevent touching/rubbing:
  • Tape a hard plastic eye shield, paper cup, or plastic cup over the eye 1

When to Seek Immediate Medical Attention:

• Metal foreign bodies require professional removal, especially if:
  • The injury resulted from high-velocity mechanisms (grinding, nailing, machinery) 1
  • The foreign body is embedded or penetrating 1, 2
  • There is eye bleeding, irregular pupil, or vision loss 1
  • The foreign body sensation persists 1
  • The injury is associated with contact lens use 1

Medical Management (For Healthcare Providers)

Metal foreign bodies in the eye require careful professional management due to several risks:

1. Infection risk: Metal foreign bodies can introduce bacteria like Amycolatopsis sulphurea, causing endophthalmitis 2

2. Corneal damage: Metal fragments can cause lacerations and scarring 3

3. MRI complications: Undetected metallic foreign bodies can move during MRI procedures, causing hyphema and further damage 4

4. Chemical reactions: Different metals can cause different ophthalmic reactions 5

Professional Removal Procedure:

1. Conduct slit lamp examination to locate and assess the foreign body 6
2. For superficial metal foreign bodies:
   • Apply topical anesthetic
   • Remove using specialized instruments under magnification
   • Evaluate for corneal rust ring (may require separate removal)
3. For embedded or intraocular foreign bodies:
   • Surgical intervention is typically required 2, 3
   • Prophylactic antibiotics (topical and systemic) are recommended 2, 3

Post-Removal Care:

• Over-the-counter oral acetaminophen or NSAIDs may be used for residual discomfort 1
• Follow-up examination to ensure complete removal and healing
• Monitor for signs of infection or complications

Common Pitfalls to Avoid

1. Self-removal attempts: Can push the foreign body deeper or cause corneal abrasions
2. Delayed medical attention: Metal foreign bodies can cause rust rings and progressive damage
3. Inadequate history: Failing to identify high-velocity injuries that require more urgent care
4. Incomplete removal: Leaving rust residue can lead to ongoing inflammation
5. Missing intraocular penetration: What appears superficial may have deeper components

Metal eye injuries are particularly common in occupational settings, especially during grinding activities or automotive work 5. Proper eye protection should always be worn during these activities to prevent such injuries.