eMedicine Specialties > Ophthalmology > Cornea

Corneal Foreign Body: Differential Diagnoses & Workup

Author: Mounir Bashour, MD, CM, FRCS(C), PhD, FACS, Assistant Professor of Ophthalmology, McGill University; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD
Contributor Information and Disclosures

Updated: Jun 30, 2008

Differential Diagnoses

Corneal Abrasion
Foreign Body, Intraocular
Keratitis, Bacterial
Keratitis, Fungal

Other Problems to Be Considered

Any eye after trauma, especially with a foreign body, needs to be evaluated for a ruptured globe and an intraocular foreign body.

Consider the possibility of an underlying corneal sensation problem. In this setting, corneal abrasions may heal poorly and may recur easily if a problem exists with corneal sensation. See Keratopathy, Neurotrophic.

Workup

Laboratory Studies

  • Unless an infectious corneal infiltrate/ulcer or an intraocular foreign body is suspected, no laboratory work is indicated.
  • Infectious corneal infiltrates/ulcers generally require scrapings for smears and cultures.

Imaging Studies

  • To exclude intraocular or intraorbital foreign body, consider B-scan ultrasound, orbital CT scan (1-mm axial and coronal cuts), and/or ultrasound biomicroscopy (UBM). If the foreign body is metallic, the initial study may include orbital x-ray films. If plain films are negative and a high suspicion still exists for intraocular foreign body, the previously mentioned studies are indicated. These studies should be complemented by a full-dilated examination by an ophthalmologist.
  • Avoid MRI if a possible history of metallic foreign body exists.
  • UBM, with high-frequency ultrasound, is often useful to rule out a foreign body embedded in the anterior sclera. These foreign bodies may not be visible because of their nature (eg, glass) or overlying opacity (eg, conjunctival hemorrhage).

Other Tests

  • A Seidel test is performed to rule out corneal perforation in the setting of a deep corneal foreign body.
  • The lower and upper lids need to be everted to look for additional foreign bodies. If a superficial foreign body is suspected but not found, double eversion of the upper lid to search for a foreign body is required.

Procedures

  • Corneal foreign bodies are removed using a sterile foreign body spud or needle after topical anesthesia. Antibiotic is applied to the eye before and after the removal. Cotton-tipped applicators often are not appropriate because of the large surface area of cotton that touches the cornea, potentially creating a large epithelial defect. Because of the risk of corneal scarring and inadvertent globe perforation, this procedure should be completed using a slit lamp biomicroscope and performed by a clinician who is well trained and experienced in corneal foreign body removal.
  • Rust rings that remain in the cornea after removal of a metallic foreign body may require removal with a rust ring drill. This procedure also should be performed using a slit lamp biomicroscope by a clinician who is well trained and experienced in rust ring removal because of the risk of corneal scarring and inadvertent globe perforation.

More on Corneal Foreign Body

Overview: Corneal Foreign Body
Differential Diagnoses & Workup: Corneal Foreign Body
Treatment & Medication: Corneal Foreign Body
Follow-up: Corneal Foreign Body
References
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References

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Further Reading

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Keywords

foreign material, cornea, foreign object, corneal abrasion, globe perforation, ocular trauma, ocular injury, rust ring

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Contributor Information and Disclosures

Author

Mounir Bashour, MD, CM, FRCS(C), PhD, FACS, Assistant Professor of Ophthalmology, McGill University; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD
Mounir Bashour, MD, CM, FRCS(C), PhD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American College of International Physicians, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, American Society of Mechanical Engineers, American Society of Ophthalmic Plastic and Reconstructive Surgery, Biomedical Engineering Society, Canadian Medical Association, Canadian Ophthalmological Society, Contact Lens Association of Ophthalmologists, International College of Surgeons US Section, Ontario Medical Association, Quebec Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Medical Editor

Kilbourn Gordon III, MD, FACEP, Urgent Care Physician
Kilbourn Gordon III, MD, FACEP is a member of the following medical societies: American Academy of Ophthalmology and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Institute
Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Eye Bank Association of America, Pennsylvania Medical Society, and Philadelphia County Medical Society
Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

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