eMedicine Specialties > Ophthalmology > Cornea

Corneal Foreign Body: Treatment & Medication

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

Treatment

Medical Care

Management objectives include relieving pain, avoiding infection, and preventing permanent loss of function.

  • Topical antibiotic drops (eg, polymyxin B sulfate-trimethoprim [Polytrim], ofloxacin [Ocuflox], tobramycin [Tobrex] qid) or ointment (eg, bacitracin [AK-Tracin], ciprofloxacin [Ciloxan] qid) should be prescribed until the epithelial defect heals to prevent infection.
  • Topical cycloplegic (cyclopentolate 1% qd/bid) can be considered for pain and photophobia, although a review of the literature shows that they are not effective1,2
  • Pressure patch or bandage contact lens is best avoided (unless the epithelial defect is >10 mm2 and then bandage contact lens may be the better option).1,3,4 The following scenarios represent high risk for the patient to develop permanent vision loss. Do not patch if any of the following are present:
    • A chance of a perforation of the globe exists.
    • A corneal infiltrate is present.
    • A chance of a retained intraocular foreign body is possible.

Surgical Care

  • Remove the foreign body using irrigation, a sterile needle, or a foreign body removal instrument. Do not remove if likelihood of penetration through more than 25% of the cornea exists.
  • Remove a rust ring with an Alger brush or automated burr. Only those clinicians who are trained in and regularly perform this procedure should complete it.

Consultations

  • Immediately refer to an ophthalmologist in case of the following:
    • Hyphema (blood in the anterior chamber)
    • Diffuse corneal damage (focal or diffuse opacity)
    • Scleral or corneal laceration
    • Lid edema
    • Diffuse subconjunctival hemorrhage
    • Posttraumatic dilation of pupil or abnormal shape of pupil
    • Abnormally shallow or deep anterior chamber compared to the fellow eye
    • Persistent corneal defect or corneal opacity
    • Any case with possible full penetration of the cornea or sclera

Medication

An uncomplicated case in which the foreign body is removed can be treated with standard antibiotics. If a large epithelial defect is present, an antibiotic ointment is placed prior to the use of a patch. Complicated cases should be seen by an ophthalmologist immediately and prior to any therapy. For example, if an infiltrate is present, the ophthalmologist may want to scrape and plate the lesion before any antibiotic is instilled in the eye.

Antibiotics

Prevent infection of an open corneal abrasion.


Polymyxin B sulfate-trimethoprim (Polytrim)

For ocular infections, involving cornea or conjunctiva, resulting from strains of microorganisms susceptible to this antibiotic. Available as a solution and ointment. Trimethoprim and polymyxin B are rarely sensitizing, and they have a wide spectrum of action in combination.
Gram-positive: S aureus, S epidermidis, Streptococcus species (group A beta-hemolytic and nonhemolytic), S pneumoniae
Gram-negative: P aeruginosa, H influenzae, H aegyptius, E coli, K pneumoniae, P mirabilis (indole-positive), Proteus species (indole-negative), E aerogenes, C freundii, C diversus, A calcoaceticus, M lacunata (some strains), S marcescens

Adult

1 gtt qid

Pediatric

<2 months: Not established
>2 months: 1 gtt qid

Documented hypersensitivity; viral, fungal, and mycobacterial infections of the eye

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Do not use in deep ocular infections or in those likely to become systemic; prolonged use of antibiotics or repeated therapy may result in bacterial or fungal overgrowth of nonsusceptible organism; if redness, irritation, swelling, or pain persists or increases, discontinue use immediately and reevaluate therapy; patient should avoid contamination of the dropper


Tobramycin (Tobrex)

Like other aminoglycosides, the bactericidal activity of tobramycin is accomplished by specific inhibition of normal protein synthesis in susceptible bacteria, but very little presently is known about this action. May inhibit bacterial mRNA synthesis, causing inhibition of bacterial growth.

Adult

1 gtt qid

Pediatric

Administer as in adults

Effects of this drug are decreased when used concurrently with gentamicin

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Do not use in deep-seated ocular infections or in those that may become systemic; prolonged use of antibiotics may result in bacterial or fungal overgrowth of nonsusceptible organisms


Ofloxacin (Floxin)

Pyridine carboxylic acid derivative with broad-spectrum bactericidal effect.

Adult

1 gtt qid

Pediatric

Administer as in adults

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Do not use in ocular infections that may become systemic; superinfections may occur with prolonged or repeated antibiotic therapy


Ciprofloxacin (Ciloxan)

Inhibits bacterial growth by inhibiting DNA gyrase.

Adult

0.5-inch ribbon in subconjunctival sac qid

Pediatric

Administer as in adults

Documented hypersensitivity; viral, mycobacterial, and fungal eye infections; avoid coadministration with steroid combinations after uncomplicated removal of a foreign body from cornea

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

A white crystalline precipitate located in superficial portion of corneal defect may occur (onset starts in 1-7 d); precipitate usually is cleared within 2 wk and does not adversely affect clinical course or outcome; do not use in ocular infections that may become systemic; superinfections may occur with prolonged or repeated antibiotic therapy


Bacitracin ointment (AK-Tracin, Baciguent)

Prevents transfer of mucopeptides into growing cell wall, inhibiting bacterial growth.

Adult

0.5-inch ribbon in subconjunctival sac qid

Pediatric

Administer as in adults

Documented hypersensitivity; vaccinia, varicella, epithelial herpes simplex keratitis, mycobacterial infections, and fungal diseases of the eye; patients using steroid combinations after uncomplicated removal of a corneal foreign body

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Ophthalmic ointments may delay healing of corneal epithelia; in deep-seated infections of the eye, supplement with systemic medications; prolonged use may result in overgrowth of nonsusceptible organisms


Gatifloxacin (Zymar)

Fourth-generation fluoroquinolone ophthalmic indicated for bacterial conjunctivitis. Elicits a dual mechanism of action by possessing an 8-methoxy group, thereby inhibiting the enzymes DNA gyrase and topoisomerase IV. DNA gyrase is involved in bacterial DNA replication, transcription, and repair. Topoisomerase IV is essential in chromosomal DNA partitioning during bacterial cell division. Indicated for bacterial conjunctivitis due to Corynebacterium propinquum, S aureus, Staphylococcus epidermidis, Streptococcus mitis, S pneumoniae, or H influenzae.

Adult

Days 1-2: Instill 1 gtt into affected eye(s) q2h while awake; not to exceed 8 administrations/d
Days 3-7: Instill 1 gtt into affected eye(s) up to 4 times/d while awake

Pediatric

<1 year: Not established
>1 year: Administer as in adults

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

For ophthalmic use only; commonly causes conjunctival irritation, increased lacrimation, corneal inflammation, or papillary conjunctivitis; less common adverse effects include conjunctival hemorrhage, dry eye, eye discharge, eye irritation, eye pain, eyelid swelling, headache, red eye, reduced visual acuity, or taste disturbance

Cycloplegics

For comfort of the eye and to prevent iris adhesion in cases of traumatic iritis.


Cyclopentolate HCl 0.5%-1.0% (Cyclogyl)

Cyclopentolate is an anticholinergic agent that induces relaxation of the sphincter of the iris and ciliary muscles. When applied topically to the eyes, it causes rapid, intense cycloplegic and mydriatic effects that reach a peak in 15-60 min; recovery usually occurs within 24 h. The cycloplegic and mydriatic effects are slower in onset and longer in duration in patients who have dark pigmented irises.

Adult

1 gtt qd/tid

Pediatric

Administer as in adults

Decreases effects of carbachol and cholinesterase inhibitors

Documented hypersensitivity; narrow-angle glaucoma

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Exercise caution in patients (eg, elderly patients) where increased intraocular pressure may be present; can cause toxic anticholinergic systemic adverse effects (common in children, especially infants) but incidence rare when used sparingly; compressing lacrimal sac by digital pressure for 1-3 min, following application, may minimize systemic absorption

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

  1. Peate WF. Work-related eye injuries and illnesses. Am Fam Physician. Apr 1 2007;75(7):1017-22. [Medline].

  2. Carley F, Carley S. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Mydriatics in corneal abrasion. Emerg Med J. Jul 2001;18(4):273. [Medline].

  3. Arbour JD, Brunette I, Boisjoly HM, Shi ZH, Dumas J, Guertin MC. Should we patch corneal erosions?. Arch Ophthalmol. Mar 1997;115(3):313-7. [Medline].

  4. [Best Evidence] Turner A, Rabiu M. Patching for corneal abrasion. Cochrane Database Syst Rev. 2006;(2):CD004764. [Medline].

  5. Augeri PA. Corneal foreign body removal and treatment. Optom Clin. 1991;1(4):59-70. [Medline].

  6. Aziz MA, Rahman MA. Corneal foreign body--an occupational hazard. Mymensingh Med J. Jul 2004;13(2):174-6. [Medline].

  7. Howell RM. Corneal abrasion. eMedicine Journal [serial online]. 2007;Available at http://www.emedicine.com/emerg/topic828.htm.

  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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