Foreign Body Eye Examination Procedure
Initial Assessment and Red Flags
- The American Academy of Ophthalmology recommends immediately testing visual acuity to establish baseline function and identify acute vision loss requiring urgent ophthalmology referral, then proceeding with a systematic examination prioritizing identification of globe penetration and sight-threatening injuries 1
- High-velocity mechanisms, such as grinding or metal work, carry a significantly higher risk of globe penetration and require immediate ophthalmology consultation 1, 2
- Documenting the timing of trauma, nature of foreign body material, and velocity of impact is crucial 3
- Patients should be asked about symptoms such as diplopia, vision loss, pain severity, and photophobia 1, 3
- Contact lens wear at the time of injury requires immediate lens removal and discontinuation 1, 2
Vision-Threatening Red Flags Requiring Emergency Referral
- An irregular pupil after trauma may indicate a penetrating injury 1, 2
- Eye bleeding or acute vision loss requires emergency referral 1, 2
- Visible corneal damage with ulceration, haze, opacity, or purulent discharge is a red flag 1
- Suspected intraocular foreign body requires immediate attention 4
Systematic Examination Protocol
- The American Academy of Ophthalmology recommends performing a systematic examination, including visual acuity testing, pupillary examination, intraocular pressure measurement, confrontational visual field testing, and slit-lamp biomicroscopy 1, 3
- Slit-lamp biomicroscopy should evaluate the corneal epithelium for defects, foreign body location, depth, and rust ring 1
- Anterior chamber cells should be checked, and cultures should be obtained if ≥1+ cells are present 1
Imaging Considerations
- A CT scan is required if there is any concern for a ferrous-metallic foreign body 3
- CT provides sufficient information about orbital fractures and entrapment 3
Post-Examination Management
- Broad-spectrum topical antibiotic prophylaxis, such as moxifloxacin, is recommended after foreign body removal 1, 4
- Topical NSAID, such as ketorolac, can be used for pain, photophobia, and foreign body sensation 1, 4
- Cycloplegic agent, such as cyclopentolate, can be used to reduce ciliary spasm pain 1, 4
- Oral acetaminophen or NSAIDs can be used for additional pain relief 1, 2, 4
Special Considerations
- Immediate surgical repair is indicated for CT evidence of entrapped muscle with nonresolving oculocardiac reflex or "white-eyed blow-out fracture" in children 3
- Patients should be instructed to return immediately if they experience worsening pain or vision, increasing redness, discharge or purulent material, or persistent foreign body sensation despite treatment 1, 2