Management of Eye Pain with Plastic Foreign Body on CT
A patient with eye pain and CT-confirmed plastic foreign body requires immediate ophthalmology consultation for same-day evaluation and surgical removal, as this represents a penetrating injury requiring urgent specialist intervention. 1, 2
Immediate Actions and Stabilization
Shield the eye immediately with a hard plastic eye shield or cup to prevent further trauma—do not attempt removal yourself or allow the patient to rub the eye, as this can worsen penetration or cause additional corneal damage. 1, 3
Critical Initial Assessment
Perform these baseline evaluations before ophthalmology arrival:
- Test visual acuity immediately to establish baseline function and identify acute vision loss 1, 2
- Examine pupil shape carefully—an irregular pupil indicates globe penetration and confirms the urgency of this case 1, 2
- Check for eye bleeding or vision loss, both of which mandate emergency ophthalmology consultation 1, 2
- Document the mechanism of injury—high-velocity mechanisms (grinding, metal work, nailing) carry higher risk of penetrating injury 1, 2
Why This Requires Urgent Specialist Care
The presence of plastic material visible on CT imaging inside or near the eye represents a penetrating or intraocular foreign body that requires surgical extraction under controlled conditions. 4 Attempting removal in the emergency department risks:
- Further globe penetration
- Lens capsule rupture
- Vitreous hemorrhage
- Retinal damage
- Endophthalmitis
Common pitfall: Do not be falsely reassured by plastic being "non-metallic"—any intraocular foreign body requires surgical removal regardless of material composition. 2, 4
Pre-Referral Management
While awaiting ophthalmology consultation:
- Apply topical anesthesia with proparacaine or tetracaine for examination comfort 1
- Perform slit-lamp biomicroscopy if available to evaluate corneal epithelial defects, foreign body location, and depth 1, 2
- Measure intraocular pressure as part of systematic examination 2
- Check for anterior chamber cells—if ≥1+ cells are present, obtain cultures 2
Post-Removal Prophylaxis (After Surgical Extraction)
Once the ophthalmologist has surgically removed the foreign body:
- Broad-spectrum topical antibiotic prophylaxis: moxifloxacin or levofloxacin four times daily 1, 2
- Topical NSAID (ketorolac) for pain, photophobia, and foreign body sensation 1, 2
- Cycloplegic agent (cyclopentolate) to reduce ciliary spasm pain 2
- Oral acetaminophen or NSAIDs for additional pain relief 2, 3
Mandatory Follow-Up
- Ophthalmology follow-up within 24-48 hours after foreign body removal to monitor for infection development 1
- Daily ophthalmological review during the acute phase if there is significant epithelial damage 1
Red Flag Return Precautions
Instruct the patient to return immediately for:
- Worsening pain or vision
- Increasing redness
- Discharge or purulent material
- Persistent foreign body sensation despite treatment 1, 2, 3
Critical distinction: Unlike superficial corneal foreign bodies that can be removed at the slit lamp, a CT-visible plastic foreign body represents a deeper, penetrating injury requiring operating room conditions for safe extraction. 4