eMedicine Specialties > Ophthalmology > Cornea

Corneal Foreign Body: Follow-up

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

Follow-up

Further Inpatient Care

  • Foreign bodies that present any potential for intraocular penetration must by explored in the operating room. These injuries should be explored within 24 hours of initial examination.

Further Outpatient Care

  • Follow up every 2 days until the epithelial defect is well healed and any corneal infiltrates have resolved.
  • Perform a gonioscopy after the resolution of the problem, and consider annual follow-up care for intraocular pressure if the severity of trauma raises a suspicion for angle-recession glaucoma in later life.
  • A dilated fundus examination should be performed on a routine basis after any injury severe enough to potentially damage the retina.

Deterrence/Prevention

  • Wear safety goggles in any situation (eg, sports, construction, workshops, industry) that has a high risk of particles or objects flying into the eyes.

Complications

  • Rust ring usually is due to an iron foreign body and can be removed carefully at a slit lamp using a burr.
  • Infectious keratitis is common in organic injuries and in neglected cases. It may need to be scraped for smears and cultures. It needs to be treated aggressively with topical antibiotics.
  • Globe perforation occurs in metal-on-metal and similar high-speed type injuries. It also can occur if a corneal ulcer is neglected. It requires surgical repair.

Prognosis

  • Good prognosis exists unless a rust ring or scarring involves the visual axis. If infection develops, prognosis is more guarded. Globe penetrating injuries and intraocular foreign bodies are separate categories and have much worse prognoses.

Patient Education

  • Remind patients of the importance of wearing protective eyewear in any high-risk situation.
  • Eyes should not be rubbed while working with wood or metal pieces.
  • If a foreign body enters the eye, the eye should not be rubbed and no attempt should be made by the patient to remove the foreign body.
  • For excellent patient education resources, visit eMedicine's Eye and Vision Center. Also, see eMedicine's patient education articles Eye Injuries and Foreign Body, Eye.

Miscellaneous

Medicolegal Pitfalls

  • Vision should be checked in each eye separately prior to proceeding with any extensive ocular examination or treatment.
  • When a corneal foreign body encroaches on the visual axis, before proceeding, inform the patient about the potential loss of visual acuity because of unavoidable scarring. This conversation should be well documented to avoid negative clinicolegal ramifications.
  • If the clinician is unable to rule out the possibility of a perforating ocular injury, apply a shield to the eye and immediately refer the patient to a nearby hospital or ophthalmology practice.
    • Remember that an intraocular foreign body may show no external eye findings and that a full-dilated examination is necessary to visualize all aspects of the eye.
    • If the examination in the office or the emergency department is not good enough to rule out a foreign body or ocular perforation, then an examination under anesthesia should be considered. This is especially true for children, where there should be a low threshold to examine the patient in the operating room.
 


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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  8. Hulbert MF. Efficacy of eyepad in corneal healing after corneal foreign body removal. Lancet. Mar 16 1991;337(8742):643. [Medline].

  9. Jayamanne DG, Bell RW. Non-penetrating corneal foreign body injuries: factors affecting delay in rehabilitation of patients. J Accid Emerg Med. Sep 1994;11(3):195-7. [Medline].

  10. Kaiser PK. A comparison of pressure patching versus no patching for corneal abrasions due to trauma or foreign body removal. Corneal Abrasion Patching Study Group. Ophthalmology. Dec 1995;102(12):1936-42. [Medline].

  11. Kay-Wilson LG. Localisation of corneal foreign bodies. Br J Ophthalmol. Dec 1992;76(12):741-2. [Medline].

  12. Newell SW. Management of corneal foreign bodies. Am Fam Physician. Feb 1985;31(2):149-56. [Medline].

  13. Yang X. Removal of corneal foreign bodies that project into the anterior chamber: use of a suture needle. Am J Ophthalmol. Jun 2000;129(6):801-2. [Medline].

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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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