Initial Management of Metal Shard Lodged in the Eye
Apply a protective shield to the affected eye immediately and arrange urgent ophthalmology referral—do not attempt removal or irrigation of an embedded metallic foreign body. 1, 2
Immediate Stabilization (Before Ophthalmology Evaluation)
The correct answer is B. Apply shield to the affected eye, followed immediately by A. Referral to ophthalmology. These are sequential steps that must both occur urgently.
Why Shielding Comes First
- 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 that could embed the foreign body deeper or cause additional damage 1, 3
- Never apply a patch, as this creates pressure on a potentially perforated globe and may push the foreign body deeper or worsen intraocular damage 1, 3, 4
- Do not rub or manipulate the eye under any circumstances, as this can cause catastrophic additional injury 1, 3
Why Removal is Contraindicated
- Never attempt removal or irrigation of embedded metallic foreign bodies in primary care or emergency settings—this requires specialized ophthalmologic surgical expertise 1, 2
- Metal shards represent high-velocity penetrating injuries that are beyond the scope of primary care removal 1
- Attempted removal can cause additional corneal damage, push the foreign body deeper into the globe, or convert a partial-thickness injury into a full-thickness perforation 1, 5
Urgent Ophthalmology Referral
- Immediate ophthalmology consultation is mandatory for any metal object lodged in the eye, as this is a sight-threatening emergency requiring specialized evaluation and surgical intervention 1, 2
- High-velocity eye injuries from grinding, hammering, or machinery demand immediate medical attention and represent potential open globe injuries 2, 6
- Metal foreign bodies embedded in the eye have significant risk for poor visual outcomes, with only 31% achieving final visual acuity of 20/50 or better and 8% requiring enucleation 6
Additional Immediate Management
- Provide oral analgesics for pain control while awaiting specialist evaluation 1
- Administer tetanus prophylaxis if indicated 4
- Start antiemetics if nausea is present 4
- Obtain CT scan (not MRI) if imaging is needed—CT is the imaging modality of choice for suspected metallic foreign bodies 1, 3
Critical Pitfall to Avoid
MRI is absolutely contraindicated if metallic intraocular foreign body is suspected, as ferromagnetic material can move catastrophically within the eye causing devastating damage 1, 3. Always obtain CT first to rule out metallic foreign body before considering any MRI 1, 2.
Why Outpatient Follow-Up is Inappropriate
Option D (outpatient follow-up) is dangerous because metallic intraocular foreign bodies can cause progressive damage including endophthalmitis, retinal detachment, and sympathetic ophthalmia if not urgently addressed 6, 7. These injuries require same-day ophthalmologic surgical intervention, not delayed outpatient management 1, 2.