Management of Red Eye After Non-Penetrating Foreign Body Removal
After removing a non-penetrating ocular foreign body, initiate broad-spectrum topical antibiotic prophylaxis (moxifloxacin or gatifloxacin four times daily), provide pain control with topical NSAIDs (ketorolac) and oral analgesics, and ensure mandatory ophthalmology follow-up within 24-48 hours to monitor for infection. 1, 2
Immediate Post-Removal Treatment Protocol
Antibiotic Prophylaxis
- Apply broad-spectrum topical antibiotics immediately after foreign body removal to prevent bacterial superinfection, with moxifloxacin four times daily or gatifloxacin as first-line agents. 1, 2
- For contact lens-related injuries, use antipseudomonal topical antibiotics specifically to cover Pseudomonas risk. 3
- Avoid topical steroids, as they may promote ulceration from fungal contaminants. 4
Pain Management (Multi-Modal Approach)
- Topical NSAIDs (ketorolac tromethamine) are the primary agent for pain, photophobia, and foreign body sensation relief. 1, 2
- Add oral acetaminophen or NSAIDs for additional systemic pain control. 1, 2
- Consider cycloplegic agents (cyclopentolate) specifically to reduce ciliary spasm pain and anterior segment inflammation. 1, 2
- Never prescribe topical anesthetics for home use, as they can mask pain from retained tarsal foreign bodies or developing corneal ulcers. 4
Critical Follow-Up Requirements
Mandatory Reassessment Timeline
- All patients require ophthalmology follow-up within 24-48 hours after foreign body removal to assess for corneal infection development. 1
- For metallic foreign bodies, specific assessment for rust ring formation and ensuring complete removal is essential at follow-up. 1
Red Flags Requiring Immediate Return
- Worsening pain or vision despite treatment 1, 2
- Increasing redness or discharge (particularly purulent material) 1
- Persistent foreign body sensation despite appropriate treatment 1, 5
- Development of corneal infiltrates or ulceration 1
Special Considerations
When Cultures Are Indicated
- Corneal foreign bodies with associated infiltrates, particularly central or large infiltrates with significant stromal involvement or melting 1
- Presence of ≥1+ cells in the anterior chamber 1
- Multiple corneal infiltrates or atypical features 1
Protective Measures
- Shield the eye with a hard plastic eye shield, paper cup, or plastic cup to prevent unintentional touching or rubbing. 1, 5
- Do not patch the eye, as evidence shows patching does not improve pain and may delay healing. 6, 3
Common Pitfalls to Avoid
- Never use topical steroids in the acute setting, as they increase risk of fungal superinfection and corneal ulceration. 4
- Never send patients home with topical anesthetics, which mask symptoms of complications. 4
- Do not assume small abrasions are benign—all patients need clear return precautions and most require follow-up. 1, 3
- Ensure eyelid eversion was performed to check for retained tarsal conjunctival foreign bodies before declaring removal complete. 1