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:

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.

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:

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

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.

Medication

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Author

Mounir Bashour, MD, PhD, CM, FRCSC, FACS Assistant Professor of Ophthalmology, McGill University Faculty of Medicine; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD

Mounir Bashour, MD, PhD, CM, FRCSC, 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, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Christopher J Rapuano, MD Professor, Department of Ophthalmology, Sidney Kimmel Medical College of Thomas Jefferson University; Director of the Cornea Service, Wills Eye Hospital

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Ophthalmological Society, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: AAO; OMIC; American Society of Ophthalmic Trauma (ASOT); Avellino, Baxis; Bio-Tissue; Celularity; Dompe; Emmecell; Glaukos; Kala; Oyster Point; Sun Ophthalmics; Tarsus; TearLab<br/>Serve(d) as a speaker or a member of a speakers bureau for: Glaukos; Dompe; Bio-Tissue<br/>Received research grant from: Glaukos<br/>Received income in an amount equal to or greater than $250 from: AAO; OMIC; Baxis; Bio-Tissue; Cellularity; Dompe; Glaukos; Kala; Sun Ophthalmics; TearLab<br/>stock options for: RPS, Fount Bio.

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, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

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, Wilderness Medical Society

Disclosure: Nothing to disclose.