What is the treatment for a cactus spine (foreign body) in the eye?

Treatment for Cactus Spine in the Eye

Do not rub the eye and seek immediate ophthalmologic evaluation for removal of the cactus spine under magnification, followed by topical antibiotics and pain management. 1, 2

Immediate Actions

• Do not rub the eye as this will embed the spine deeper into the corneal tissue and cause further damage 1
• 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
• Seek immediate medical attention - cactus spines in the eye constitute a penetrating foreign body that requires professional removal 2

Why Cactus Spines Require Special Attention

• Cactus spines are semitranslucent and difficult to visualize in corneal tissue, making them challenging to locate and remove completely 3
• Multiple spines (80-90 in documented cases) can embed in the cornea, with some penetrating into the anterior chamber 3
• The spines are barbed or spiculated, making simple removal difficult even with tweezers 4, 5
• Retained spine fragments can cause granulomatous inflammation that persists for months if not properly removed 6

Professional Removal Technique

• Removal under magnification (slit lamp or operating microscope) is essential for complete extraction 3
• Fiberoptic illumination provides superior visualization of the semitranslucent spines and is the recommended technique for cactus spine removal from the cornea 3
• If the spine is embedded or difficult to remove, immediate referral to an ophthalmologist is mandatory 2
• Irrigate the eye with sterile saline or commercial eye wash solution after removal to flush any loose fragments 2

Post-Removal Treatment

• Apply broad-spectrum topical antibiotic prophylaxis (e.g., moxifloxacin drops four times daily) to prevent infection 2
• Topical NSAID such as ketorolac tromethamine ophthalmic solution for pain relief, photophobia, and foreign body sensation 2
• Oral analgesics (acetaminophen or NSAIDs) for additional pain control 1, 2
• Cycloplegic agents (e.g., cyclopentolate) may be used to decrease pain from ciliary spasm if significant anterior segment inflammation is present 2

Critical Pitfalls to Avoid

• Never attempt self-removal - cactus spines require professional extraction under magnification 3
• Do not use eye patching as this is not recommended for corneal foreign bodies 2
• Do not delay seeking care - high-velocity or penetrating eye injuries require immediate ophthalmologic evaluation 1, 2
• Watch for retained fragments - incomplete removal leads to persistent inflammation and granuloma formation 6

Red Flags Requiring Immediate Ophthalmology Referral

• Any suspicion of intraocular foreign body or penetration into the anterior chamber 2
• Irregular pupil, eye bleeding, or vision loss after the injury 1
• Persistent foreign body sensation despite attempted removal 1
• Multiple embedded spines that cannot be visualized with standard examination 3