Management of Ocular Foreign Body and Corneal Abrasion
Immediate Assessment and Red Flags
Test visual acuity immediately to establish baseline function and identify any acute vision loss requiring urgent ophthalmology referral 1.
Critical Red Flags Requiring Emergency Ophthalmology Referral (<24 hours):
- High-velocity mechanism (grinding, nailing, metal work) - higher risk of globe penetration 1
- Irregular pupil after trauma - indicates penetrating injury 2, 1
- Eye bleeding or vision loss after trauma 2
- Pain (moderate-to-severe, not just irritation) 3
- Photophobia (intolerance to light) 3
- Visible corneal damage (uptake of fluorescein, ulceration, haze, opacity, purulent discharge) 3
- Contact lens-related injury - requires immediate removal and discontinuation 2
Initial Management for Low-Energy Foreign Bodies
Do NOT:
- Never rub the eye - this embeds the foreign body deeper and causes corneal abrasion 2
DO:
- Irrigate with sterile saline to flush loose material first 1
- Allow natural tears to wash out the object or use tap water/commercial eye wash 2
- Shield the eye with hard plastic eye shield, paper cup, or plastic cup to prevent unintentional touching 2
Foreign Body Removal and Post-Removal Treatment
After Successful Removal:
- Broad-spectrum topical antibiotic prophylaxis (e.g., moxifloxacin four times daily or gatifloxacin) 1, 4
- Topical NSAID (ketorolac) for pain, photophobia, and foreign body sensation 1
- Cycloplegic agent (cyclopentolate) to reduce ciliary spasm pain 1
- Oral acetaminophen or NSAIDs for additional pain relief 2, 1
Critical Pitfall to Avoid:
Do NOT use topical corticosteroids - a case report demonstrated corneal perforation from topical steroid use after foreign body removal due to corneal melting 5. The combination of steroids, delayed extraction, and NSAIDs led to perforation 5.
Describing a Corneal Scratch/Abrasion to Ophthalmology
When discussing with ophthalmology, provide:
- Visual acuity (baseline function) 1
- Mechanism of injury (low vs. high-velocity) 1
- Location and depth of corneal involvement (superficial vs. stromal) 4
- Presence of fluorescein uptake (indicates epithelial defect) 3
- Size of abrasion (measured in millimeters)
- Presence of rust ring (if metallic foreign body) 1
- Any red flag features (irregular pupil, vision loss, severe pain, photophobia) 3, 2, 1
- Corneal sensitivity status - test this, as corneal anesthesia enhances risk of melting and perforation 5
Patient Advice
What to Expect:
- Close follow-up within 24-48 hours is mandatory to assess for corneal infection development 1
- Persistent symptoms require specialist evaluation 1
- Most corneal abrasions heal within 1-2 weeks with appropriate treatment 6
Warning Signs to Return Immediately:
- Worsening pain or vision
- Increasing redness
- Discharge or purulent material
- Persistent foreign body sensation despite treatment 2
Prevention:
- Protective eyewear is essential for occupational activities (construction, welding, grinding) 7, 8
- Most injuries occur despite availability of protective devices, emphasizing need for proper supervision and correct use 8
Follow-Up Requirements
All patients require ophthalmology follow-up within 24-48 hours after foreign body removal to monitor for infection 1. For metallic foreign bodies, assess for rust ring formation and ensure complete removal 1.