FOREIGN BODIES IN THE EYE

This extends the general method for an eye injury in Section 60.1. Look for an entry wound in: (1) the patient’s lids, (2) his sclera, or (3) his cornea. Stain his cornea. Feel the tension in his globe. Examine his anterior chamber for a hyphema, and his iris for a tear. Look for the foreign body with an ophthalmoscope.

CAUTION! The entry wound in his cornea may be a very small one indeed. Look for a tiny haemorrhage.

CONJUNCTIVAL FOREIGN BODIES

If a patient complains that something has got into his eye, you will probably find it in his upper or lower conjunctival fornix, usually the upper one. Search both, and evert his upper lid, as in B, Fig. 60-8. You will probably find the foreign body about 3 mm from the margin of his lid, about half way along, where it is most concave. Brush the foreign body away with a cotton wool swab on a match stick. Don’t be content with only finding one; expect to find several more.

If he complains of a foreign body but you cannot see it, be sure to instil fluorescein. You may see an abrasion, a laceration, or a foreign body.

If the foreign body is embedded in his conjunctiva, instil a few drops of local anaesthetic, pick it up with forceps and snip it out with the overlying conjunctiva.

If fragments of spectacle glass have gone into his eye, remove them with forceps, and sweep them out of his fornices with a cotton wool swab on a match stick.

CAUTION! Always examine a patient’s cornea carefully, and stain it with fluorescein, even if you find a foreign body in his conjunctiva.

CORNEAL FOREIGN BODIES

The patient’s eye is painful, red, tearful, and photophobic. You will need great care, a steady hand, 5% cocaine, or 4% or 2% lignocaine, good magnification, and a strong light. The sun is ideal. Stain his cornea with fluorescein, hold his eye open, and examine his cornea.

If you can see a corneal foreign body, wipe it away with a swab or moist cotton tipped applicator.

If the foreign body is firmly attached to his cornea, put the tip of a sterile disposable hypodermic needle under it, and lift it out of its small pit in his cornea.

CAUTION! (1) Don’t damage the surrounding normal cornea. (2) The cornea is thin (1 mm) and tough, so don’t push the foreign body through it into his anterior chamber. (3) Use a fine sharp needle, not a corneal spud.

If fluorescein shows vertical corneal stains, a foreign body has stuck to the deep surface of the patient’s upper lid, and is scratching his cornea. Evert his upper lid, and remove the foreign body by rubbing it with a swab.

If an iron containing foreign body has remained in the cornea for any length of time, a ring of rust forms. You must remove the foreign body, but if you cannot easily lift out the rust ring, leave it.

CAUTION! Whenever there is or has been a foreign body in a patient’s eye, instil antibiotic drops, and pad it.

POSTOPERATIVELY On the following day, stain the patient’s cornea with fluorescein.

If there is any area of staining and his eye looks irritated, dilate his pupil with 1% atropine and bandage his eye.

INTRAOCULAR FOREIGN BODIES Take lateral double exposure X-rays of the patient’s orbit with his eye in two positions, looking up and down. If the foreign body changes its position in these two views, it is probably inside his eye. If it is a metallic foreign body, refer him for its removal. This highly specialized procedure is beyond the competence even of most ophthalmic surgeons. If it is a small splinter of sand or glass, leave it.

ORBITAL FOREIGN BODIES If possible, leave them.

Figure 60.9: A PENETRATING INJURY OF THE GLOBE. This patient has a penetrating injury well above his eye. The bleeding into his conjunctiva should however make you suspcicious. Only when he looks downwards and inwards (B) do you see the injury of his globe. After Goldberg and Tessler.