Many patients present to the ophthalmologist in OPD or ER with Foreign body sensations. many of them are welders. foreign bodies can be of many types like organic, inorganic, metallic, inert etc. removing them is the main stream line of treatment.

1. Dr. Muhammad Jawad Awan
1st year resident
Ophthalmology BBH

2. Objectives
 Basics
 Clinical Presentation
 Practical scenario
 Treatment modalities
 Specialist care

3.  The most common presenting complaint of
Ophthalmology in Emergency dept. is Foreign body
sensation, so just to recall the basics of Ophthalm in
ED

4. Basics:
 Foreign body classification
 Toxic –
 Metallic
 Magnetic – iron, steel, nickel
 Non magnetic – copper, aluminum, mercury, zinc
 Non-metallic – vegetative matter
 Inert
 Metallic – Gold, silver, platinum
 Non-metallic – Glass, carbon, stone, porcelain,
plaster, rubber

5. Clinical presentation:
 Foreign body sensation
 Irritation
 Photophobia
 Epiphora
 Redness

6. Practical Scenario
 History of event
 Place or location of trauma
 High / low velocity
 Examination – Inspection (both eyes!)
 Simultaneous irrigation with saline – Watch for small
FB particles – Cotton tip – moistened applicator – 25G
needle on syringe

7. Examination
Upper lid eversion and conjunctival fornices
examination

8. Treatment Modalities
Moistened Cotton tip applicator Moistened Cotton tip applicator

9. Topical Anesthetic Eye drops
Proparacaine 0.5% to anesthetize cornea before attempted FB removal.
Anesthetizing both eyes is helpful, as it eliminates reflex blinking.

10. Fluorescein eye test
 Indications
 Suspected FB
 Abrasions
 Infections

11. Topical antibiotics
 Moxifloxacin

12. Specialist Consultation
 Hyphema
 Diffuse corneal damage
 Scleral / corneal laceration
 Lid edema
 Diffuse subconjunctival hemorrhage Posttraumatic
pupillary dilatation/ abnormal pupil shape
 Abnormally shallow/ deep anterior chamber compared
to fellow eye
 Persistent corneal defect / corneal opacity
 Possibility of full penetration / sclera

13. Complications
 Rust ring usually due to an iron FB
 Infectious Keratitis is common in organic injuries and
neglected cases
 Globe perforation occurs in metal-on-metal and
similar high speed type injuries.

14. Patient Education
 Remind patients of the importance of wearing
PROTECTIVE EYE-WEAR in any high risk situation.
 Eyes should not be rubbed while working with wood /
metal pieces.
 If a FB enters the eye, the eye should not be rubbed or
no attempt should be made by the patient to remove
the FB

15. Thank you