# Foreign Body Removal- Eye (Superficial)

## Overview

This module describes how to remove superficial foreign bodies from the eye.

## Indications

1. Superficial foreign body on the ocular surface (cornea/conjunctiva)

## Contraindications

1. Suspected penetrating eye injury or intraocular foreign body—call ophthalmology

2. Uncooperative patient—call ophthalmology

3. Foreign body is in the visual axis—call ophthalmology

## Patient information & consent

Always verify your patient’s identity and obtain informed consent before proceeding.

### How do I explain this procedure?

“There is a foreign object stuck on the surface of your eye and I need to remove it.”

### What can my patient expect?

“I’ll give you an eye drop to reduce pain, and then we’ll rinse your eye with lots of water. It will be uncomfortable. Then I will try to remove the object by scooping it up with a cotton bud or the side of a needle. I will not stick the needle into your eye. If I can’t get the object out, I’ll call the ophthalmologist to help. ”

### What is my patient’s role?

“Let me know if you’re allergic to anything. It is important that you try not to squeeze your eyes shut, look straight ahead (not at my hand), and don’t move your head or eyes around. Do not make any sudden movements or grasp my hands.”

## Preparation

###

### Documentation

1. Patient notes

2. If injury on duty, use appropriate documentation

### Equipment

1. Alcohol-based hand rub

2. Local anaesthetic: 0.5% proparacaine drops

3. Equipment for eye irrigation

4. Cotton-tipped applicators

5. IV cannula

6. 25-27 G needle attached to a small syringe

7. Fluorescein

8. Chloramphenicol eye ointment

## Site & Positioning

Position the patient reclining. The patient should look at a fixed point ahead of them.

## Procedure

Follow medical asepsis without gloves.

1. Perform hand hygiene.

2. Instil fluorescein into the eye and examine under blue light for the

   Seidel sign
   Seidel sign

   Fluorescein accumulates around the foreign body and makes it more visible. The Seidel sign is a disturbance in the surface fluorescein by the flow of aqueous humour from a perforating injury.

   ; if this is present, stop, patch the eye and call ophthalmology. Identify the foreign body.

3. Instil an anaesthetic drop into the eye.

4. Irrigate the eye.

5. If unsuccessful, attempt to sweep away the object with a cotton-tipped applicator.

6. If unsuccessful, use the bevel of an IV cannula (with the needle removed) to attempt

   lifting
   lifting

   Hold the tip bevel-up, parallel to the surface of the eye, not perpendicular to it. Work from the outside of the eye inward, so you do not cross the field of vision any more than necessary. Stabilise the heel of your hand on the patient's cheekbone so that if they move their head, your hand moves too.

   or scooping away the object.

7. If unsuccessful, use the bevel of a needle attached to a syringe in the same fashion to lift away the object.

8. After removing the foreign body, repeat the fluorescein examination to confirm an absent Seidel sign and to determine the size of the epithelial defect.

9. Assess the cornea for a

   rust ring
   rust ring

   See Troubleshooting for how to deal with a rust ring.

   .

10. Instil antibiotic eye ointment and apply an eye patch.

11. Dispose of medical waste safely.

12. Record completion of the procedure in patient notes.

13. Prescribe a topical antibiotic. Do not prescribe corticosteroids or local anaesthesia.

14. Follow up every day until the epithelial defect is closed or send for a 24 hour follow up with ophthalmology.

## Troubleshooting

My patient has a rust ring after I removed the foreign body.

The rust ring can be very difficult to remove directly after removing the foreign body, and doing so can cause damage to Bowman's layer and result in scar formation. Rather instill antibiotic eye ointment, patch the eye and follow up within 24 hours, when it is easier to remove the rust ring using the same technique above.

How should I follow up this patient?

Follow up every day until the epithelial defect is closed. If not closed within 48 hours refer to an ophthalmologist, because this could indicate infection.

I don’t see a foreign body, but there are markings visible on the cornea under fluorescein.

Evert

Evert

Place a cotton-tipped applicator on the upper eyelid and flip the lid upwards towards the forehead. Use the applicator to hold it in place.

the eyelid to search for a foreign body under the eyelid.

## Risks

1. Exacerbating a corneal abrasion

2. Exacerbation of a penetrating eye injury

3. Corneal perforation with a needle tip

4. Local infection

5. Sharps injury to healthcare personnel

## References

1. Brady CJ. How to Remove a Foreign Body from the Eye. 2020. MSD Manual.

2. Ehlers JP, Shah CP, eds. The Wills Eye Manual. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2008.

3. Pons J. How to treat the eye. In: Mash B, Blitz-Lindeque J, eds. South African Family Practice Manual. 2nd ed. Pretoria: Van Schaik Publishers; 2010: 138-139.