Corneal Foreign Body

  • Particle embedded in cornea
  • Usually airborne
  • Causes foreign body sensation and inflammation
  • Patient reports foreign body sensation ("sand in my eye")
  • Black or white object visible with penlight but more easily with loupe or slit lamp
  • Tear film mucus, BUT...mucus moves, corneal foreign bodies don't move 
  • Instill topical anesthetic to allow pain-free examination
  • Measure visual acuity
  • Inspect cornea with penlight, loupe, or biomicroscope
  • Try to remove foreign body with moistened cotton-tipped applicator
  • Instill fluorescein dye; look for corneal abrasions under cobalt blue light
  • Evert upper lid to make sure foreign bodies are not hiding in pre-tarsal sulcus
  • Remove foreign body with cotton-tipped applicator
  • Instill topical antibiotic and arrange follow-up examination in 24 hours (to be sure abrasion has healed)
  • Prescribe pain medication if abrasion is large
  • Leave rust rings alone; removing them may cause more damage
  • Refer emergently to ophthalmologist if you are unsuccessful in removing foreign body
  • Unremoved corneal foreign bodies may cause lingering pain, inflammation, and sometimes infection
  • Rust rings usually resolve spontaneously and harmlessly
  • Attempts at removal of foreign bodies or rust rings by unskilled personnel may lead to corneal scarring and even perforation
  • Foreign bodies leave denuded epithelium which should be handled like any abrasion