Evaluation and management of corneal foreign bodies

Insults from corneal foreigh bodies range from trivial windblown debris through destructive chemicals, penetrating wounds, and severe secondary infection. History and preliminary examination should begin concurrently, particularly in the case of chemically active compounds. Needed auxiliaries are topical anesthetics, oblique light, magnification, sterile sodium fluorescein for diagnostic staining of surface breaks, removal instruments, and topical antibiotics to reduce the potential of secondary infection. A steadied, seated position for the physician, resting posture with hands supported on the face, and an oblique approach tend to reduce the likelihood of unwanted perforations or scars. An irrigating stream of sterile saline delivered through a 25 gauge short needle on a 5 cc syringe will dislodge most recent foreign bodies. The sterile needle is also available as a spud. Corneal thickness varies from slightly above 1 mm in the periphery to less than 0.5 mm centrally. Therefore, it is essential to have clear visualization of the foreign body in relation to corneal depth. Dislodgment into the anterior chamber or incidental perforation of the cornea generally require hospitalization, intensive antibiotics, and steroid therapy.