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Foreign body in eye

Specialties > Emergency medicine and intensive care

Differential Diagnosis Schema 🧠

Foreign Body Types

  • Superficial Corneal Foreign Body: Commonly due to small particles like dust, sand, or metal shavings; may cause irritation, redness, and a sensation of something in the eye.
  • Intraocular Foreign Body: More serious, often involving high-velocity objects like metal fragments; may penetrate the cornea or sclera and can lead to vision-threatening complications.
  • Subtarsal Foreign Body: Foreign material trapped under the eyelid, causing significant discomfort, especially with eye movements.
  • Organic Foreign Body: Plant material or insects, which carry a higher risk of infection, including fungal keratitis.
  • Chemical Foreign Body: Particles contaminated with chemicals, which can cause both mechanical damage and chemical injury to the eye.
  • Embedded Foreign Body: Foreign body that is lodged within the corneal or scleral tissue, potentially requiring surgical removal.

Key Points in History 🥼

Mechanism of Injury

  • Nature of the Incident: Understanding how the injury occurred (e.g., grinding metal, gardening, or chemical exposure) helps assess the type and location of the foreign body.
  • High-Velocity Impact: High-velocity injuries, such as those from power tools, have a higher risk of intraocular foreign bodies and penetrating injuries.
  • Protective Eyewear: Assess whether the patient was wearing protective eyewear at the time of the incident, which can reduce the risk of severe injury.
  • Time Since Injury: The duration since the injury occurred can influence the risk of complications like infection or corneal scarring.
  • Symptoms: Ask about symptoms such as pain, photophobia, tearing, and visual disturbances to gauge the severity and possible location of the foreign body.

Associated Symptoms

  • Visual Disturbances: Blurred vision, double vision, or loss of vision suggests deeper or more severe injury, such as intraocular involvement.
  • Pain and Photophobia: Intense pain or light sensitivity can indicate corneal abrasion, uveitis, or deeper penetration of the foreign body.
  • Redness and Tearing: Common symptoms that occur with superficial foreign bodies but may also be present in more severe injuries.
  • Discharge: Purulent discharge may suggest secondary infection, particularly with organic foreign bodies.
  • History of Previous Eye Conditions: Conditions like dry eye, blepharitis, or previous ocular surgery can predispose the patient to complications from a foreign body.
  • Systemic Symptoms: Fever, malaise, or other systemic signs might indicate a spreading infection or a severe reaction to a retained foreign body.

Background

  • Past Medical History: Note any history of eye disease, trauma, or surgery, which may affect the management and healing of the current injury.
  • Drug History: Consider any use of anticoagulants, which could exacerbate bleeding in cases of penetrating injury, or immunosuppressants, which may affect healing and infection risk.
  • Occupation: Knowing the patient’s occupation can help identify potential ongoing risks or the need for protective measures in the future.
  • Allergies: Important to know for prescribing treatments, particularly antibiotics or local anesthetics.
  • Social History: Consider the patient’s access to follow-up care, ability to comply with treatment, and whether they live in an environment that might predispose to further injury or infection.
  • Recent Travel: Particularly relevant if there is a risk of unusual infections or if the patient was in an environment where they were exposed to organic material.

Possible Investigations 🌡️

Initial Examination

  • Visual Acuity: Assess baseline visual acuity to determine the impact of the foreign body and guide further management.
  • Slit-Lamp Examination: Essential for detailed inspection of the cornea, anterior chamber, and iris; helps identify the location, depth, and type of foreign body.
  • Eversion of Eyelids: Necessary to examine for subtarsal foreign bodies that might be missed on initial inspection.
  • Fluorescein Staining: Useful to detect corneal abrasions, epithelial defects, and subtle foreign bodies that are difficult to visualize.
  • Seidel Test: Performed if there is suspicion of globe perforation; positive if aqueous humor leakage is detected.
  • Pupil Examination: Check for irregularity or reactivity, which might indicate deeper ocular injury.

Imaging

  • Orbital X-Ray: Useful in cases of suspected metallic foreign bodies; may not detect organic material.
  • CT Scan: High-resolution imaging, particularly useful for detecting intraocular or intraorbital foreign bodies and assessing for fractures.
  • Ultrasound: Can be used to assess for intraocular foreign bodies or retinal detachment when direct visualization is difficult.
  • MRI: Generally avoided in cases where metallic foreign bodies are suspected due to the risk of movement and injury.
  • B-Scan Ultrasound: Non-invasive method to detect and localize foreign bodies, especially in the posterior segment of the eye.
  • Anterior Segment Optical Coherence Tomography (OCT): High-resolution imaging to assess the anterior segment, particularly useful for identifying subtle or embedded foreign bodies.

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Emergency medicine and intensive care