Eye Foreign Body Removal Procedure
For superficial foreign bodies, irrigate with sterile saline or commercial eye wash solution and remove visible objects with a moistened cotton swab or foreign-body spud under topical anesthesia; if the foreign body is embedded, high-velocity in origin, or cannot be easily removed, refer immediately to ophthalmology. 1
Immediate Assessment
Before attempting removal, determine the mechanism of injury to stratify risk:
- High-velocity injuries (grinding, hammering, nailing) require immediate ophthalmology referral without attempted removal due to risk of penetrating injury 2, 1
- Sharp or metal objects that may have penetrated the globe require immediate referral 2
- Red flags mandating immediate referral: irregular pupil, eye bleeding, vision loss, or suspected intraocular foreign body 2, 1
Removal Technique for Superficial Foreign Bodies
For low-energy mechanisms (dust, eyelash, debris):
- Apply topical anesthetic to facilitate examination and removal 3
- Irrigate thoroughly with sterile saline or commercial eye wash solution to flush loose material 1
- Use a moistened cotton swab for conjunctival foreign bodies or a foreign-body spud under slit lamp magnification for corneal foreign bodies 3
- Evert the upper eyelid to check for hidden foreign bodies on the tarsal conjunctiva 4
- Never attempt removal if the foreign body appears embedded in deeper corneal layers—this requires ophthalmology referral 1
Post-Removal Management
After successful removal, treat as a corneal abrasion:
- Apply broad-spectrum topical antibiotic prophylaxis (moxifloxacin drops four times daily) to prevent infection 1
- For contact lens-related injuries, use antipseudomonal coverage and discontinue lens wear immediately 2, 4
- Prescribe topical NSAIDs (ketorolac) for pain relief, which effectively reduces pain, photophobia, and foreign body sensation 1
- Add oral analgesics (acetaminophen or NSAIDs) for additional pain control 2, 1
- Consider cycloplegic agents (cyclopentolate) for significant ciliary spasm or anterior segment inflammation 1
Critical Pitfalls to Avoid
- Never patch the eye—patching does not improve pain and may delay healing 1, 4
- Never allow the patient to rub the eye, as this embeds the foreign body deeper and causes corneal abrasion 2
- Do not use topical cycloplegics routinely for simple abrasions without significant inflammation 4
- Maintain high suspicion for translucent foreign bodies (glass, plastic), which are easily missed and can remain asymptomatic for extended periods before causing delayed complications 5
Follow-Up Protocol
- Small abrasions (≤4 mm) with normal vision and resolving symptoms may not require follow-up 4
- All other patients should be reevaluated in 24 hours to assess healing and rule out infection 4
- Immediate re-referral is indicated for worsening symptoms, corneal infiltrate or ulcer, or significant vision loss 4