What is the next step for a patient with a foreign body sensation in the eye?

Management of Foreign Body Sensation in the Eye

The next step for a patient with a foreign body sensation in the eye is to avoid rubbing the eye and allow natural tears to wash out the object or irrigate with tap water/commercial eye wash solution if it's a low-energy foreign body, while seeking immediate medical attention for high-velocity injuries, penetrating injuries, or persistent symptoms. 1

Initial Assessment and Management

• Do not rub the eye as this can cause further damage by embedding the foreign body deeper or causing corneal abrasion 1
• For low-energy foreign bodies (such as eyelashes or dust):
  • Allow natural tears to wash out the object 1
  • Irrigate with tap water or commercial eye wash solution 1
  • Tape a hard plastic eye shield, paper cup, or plastic cup over the eye to prevent unintentional touching or rubbing 1
  • Take over-the-counter oral acetaminophen or NSAIDs for residual discomfort after foreign body removal 1

When to Seek Immediate Medical Attention

• Contact lens-related foreign body sensation requires immediate medical attention, including removal of the contact lens and discontinuation of use 1
• High-velocity eye injuries, such as those from grinding or nailing activities 1
• Penetrating eye injury from a sharp or metal object 1
• Irregular pupil, eye bleeding, or vision loss after trauma 1
• Persistent foreign body sensation despite home treatment 1
• Corneal foreign bodies that are not easily removed with irrigation may require specialized removal techniques 2

Common Causes of Foreign Body Sensation

• Loose foreign bodies (eyelashes, dust) 1
• Chemical injury 1
• Ultraviolet radiation exposure 1
• Eye inflammation or infection 1, 3
• Corneal abrasions 4
• Dry eye disease 3

Warning Signs and Complications

• Delayed presentation of foreign bodies can lead to serious complications, including corneal perforation 5
• Some foreign bodies may be translucent and difficult to detect, requiring thorough examination 6
• Corneal anesthesia combined with anti-inflammatory medications can lead to corneal melting and perforation 5
• Self-treatment with topical steroids without proper medical supervision can worsen outcomes 5

Treatment After Medical Evaluation

• For confirmed corneal abrasions, treatment typically includes:
  • Cycloplegic medication
  • Antibiotic ointment
  • Eye patching (unless corneal ulcer is suspected) 4
• For bacterial conjunctivitis, if diagnosed after foreign body removal, topical antibiotics may be prescribed:
  • Moxifloxacin ophthalmic solution 0.5%: one drop in affected eye 3 times a day for 7 days 7
  • Gatifloxacin ophthalmic solution 0.5%: Day 1 - one drop every two hours while awake (up to 8 times); Days 2-7 - one drop 2-4 times daily 8

Common Pitfalls to Avoid

• Rubbing the eye, which can cause further damage 1
• Ignoring persistent symptoms that require medical evaluation 1
• Self-administering topical steroids without medical supervision 5
• Failing to test corneal sensitivity in patients with corneal foreign bodies 5
• Overlooking translucent foreign bodies that may not be immediately visible 6
• Delayed treatment of foreign bodies, which can lead to epithelialization and more difficult removal 6