Management of Metal Foreign Body Lodged in the Eye
Immediate referral to ophthalmology is mandatory for a metal object lodged in the eye—do not attempt removal yourself. This is a sight-threatening emergency requiring specialized evaluation and surgical intervention by an ophthalmologist 1, 2.
Why Immediate Ophthalmology Referral is Critical
Metal foreign bodies embedded in the eye represent high-velocity penetrating injuries that require urgent specialist management. 1, 2
- High-velocity eye injuries (such as from grinding or nailing metal objects) demand immediate medical attention and are beyond the scope of primary care removal 1, 2
- Penetrating eye injuries from sharp or metal objects require immediate ophthalmology evaluation 1, 2
- These injuries carry significant risk of vision loss, with studies showing 8% of metallic intraocular foreign bodies ultimately requiring enucleation or evisceration 3
Initial Stabilization Before Transfer
While arranging urgent ophthalmology consultation, take these protective measures:
- Shield the eye immediately with a hard plastic eye shield, paper cup, or plastic cup taped over the eye to prevent unintentional touching or rubbing 1
- Do not rub or manipulate the eye, as this can embed the foreign body deeper or cause additional corneal damage 1
- Do not attempt irrigation or removal of embedded foreign bodies—this differs from superficial foreign bodies 1, 2
- Provide oral analgesics (acetaminophen or NSAIDs) for pain control while awaiting specialist evaluation 1
Why Primary Care Removal is Contraindicated
The evidence clearly distinguishes between superficial and embedded foreign bodies:
- Low-energy foreign bodies (dust, eyelashes) can be managed with irrigation and natural tearing 1
- Embedded or high-velocity metal foreign bodies require specialized surgical techniques, often including pars plana vitrectomy, electromagnets, or microscalpel extraction 4, 5
- Metallic intraocular foreign bodies frequently cause complications including vitreous hemorrhage, traumatic cataract, retinal detachment, and require multiple surgical interventions in 40% of cases 5, 3
Diagnostic Imaging Considerations
CT scan is the imaging modality of choice for suspected metallic foreign bodies—MRI is absolutely contraindicated. 6
- Noncontrast thin-section orbital CT with multiplanar reconstructions is superior for identifying metallic foreign bodies and assessing globe integrity 6
- MRI is contraindicated when metallic foreign body is suspected, as it can cause movement of ferrous metal and catastrophic ocular damage 6, 7
- Plain X-rays have poor sensitivity and specificity for detecting metallic foreign bodies and should not be relied upon 7
Red Flags Requiring Immediate Action
The following findings indicate severe injury requiring emergent ophthalmology intervention 1, 2:
- Irregular pupil shape
- Eye bleeding (hyphema or vitreous hemorrhage)
- Vision loss or significant visual impairment
- Penetrating injury with visible entry wound
Common Pitfall to Avoid
The most critical error is attempting removal of an embedded foreign body in primary care. Unlike superficial corneal foreign bodies that can sometimes be removed at the slit lamp, metal objects "lodged" in the eye indicate penetration requiring surgical expertise, specialized instruments, and often intraoperative imaging 4, 5, 3.