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 effective. [3, 4]
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). [3, 5, 6] The following scenarios represent high risk for the patient to develop permanent vision loss. Do not patch if any of the following are present:
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A chance of a perforation of the globe exists.
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A corneal infiltrate is present.
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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.
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.
Consultations
Immediately refer to an ophthalmologist in case of the following:
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Hyphema (blood in the anterior chamber)
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Diffuse corneal damage (focal or diffuse opacity)
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Scleral or corneal laceration
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Lid edema
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Diffuse subconjunctival hemorrhage
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Posttraumatic dilation of pupil or abnormal shape of pupil
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Abnormally shallow or deep anterior chamber compared to the fellow eye
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Persistent corneal defect or corneal opacity
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Any case with possible full penetration of the cornea or sclera
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.
Long-Term Monitoring
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.
