Management of Corneal Metallic Foreign Body

Immediate Assessment and Decision Algorithm

The American Academy of Ophthalmology recommends testing visual acuity immediately to establish baseline function and identify any acute vision loss that would mandate urgent ophthalmology referral 2
The American College of Emergency Physicians suggests assessing for penetrating injury or intraocular foreign body, which requires immediate ophthalmology consultation 1
High-velocity mechanism of injury (e.g., grinding, nailing, metal work) necessitates immediate ophthalmology referral, as it has a higher risk of globe penetration 3
An irregular pupil after trauma indicates penetrating injury requiring immediate referral 3

The removal process should include irrigating the eye first with sterile saline to flush loose material 1
Apply broad-spectrum topical antibiotic prophylaxis (e.g., moxifloxacin four times daily) after removal 1
Pain control should be multimodal, including topical NSAID (ketorolac) for pain, photophobia, and foreign body sensation 1
Oral acetaminophen or NSAIDs can be used for additional relief 3, 1
Cycloplegic agents (cyclopentolate) can be used to reduce ciliary spasm pain 1

All patients require close follow-up within 24-48 hours to assess for corneal infection development 1
Persistent symptoms require specialist evaluation 3