Pearls of Vision: Foreign Body Removal 

CECELIA KOETTING, OD: Hello again. It’s Cecelia Koetting coming to you from Denver, Colorado. And on this episode, what we’re going to talk about is foreign body removal. We’re going to talk about both corneal foreign body removal as well as conjunctival foreign body removal, and maybe a little bit about different techniques that people are using and different instruments that we can use.  

I think this is a great thing to get a refresher on, because while some of us, in certain settings, may see more of these — maybe once a week, or once a month and be doing them on a more frequent basis — for a lot of us, this might be something we haven’t seen in a while, and it’s great just to have a refresher as well as hear what other people are doing as far as techniques for removal.

The first step is getting a good, detailed history as to what has caused the foreign body. Was it possibly penetrating by a projectile? Or is it something that may have occurred while working on a vehicle? Here we see what looks like a small metallic foreign body in the patient’s cornea.  

When it comes to options as far as what to use to remove foreign bodies, we have lots of options. Starting with a sterile cotton tip applicator. You could also use a metal spud or the end of a needle. And then following that, to clean up, we’re going to use the Alger brush, and don’t forget to numb your patients with an anesthetic. 

In this video, we see me trying a cotton tip applicator first for a fairly superficial foreign body, gently dabbing and wiping at the area to dislodge that foreign body. Doesn’t seem to be working, does it? Well, let’s try something else next. Next, I move to a spud. We see that it’s thinner and it’s more pointed, so we’re able to get underneath that foreign body and dislodge it, taking care to make sure that we remove it from the eye so that it doesn’t end up elsewhere causing more problems or lodging itself within the cornea.

We do see that there is a leftover rust ring, so at this point, we need to remove that rust ring to decrease the risk of any scarring or adverse effect. When removing the rust ring from the patient’s cornea using an Alger brush, I typically let them hear the sound of it first before coming close to the eye. I then bring the Alger brush tip perpendicular to the cornea and press firmly, but not too hard onto the cornea to begin to clear the area, stopping multiple times to reassess and then go back to try to clear more. If the ring and the rust debris is too deep, you may need to have the patient come back on a different day to finish the job. Once finished, I place a drop of antibiotic in the eye and start the patient on antibiotics at home.  

In this picture, we see a patient who had a piece of vegetative matter that had been there for approximately 1 month before she came in to be seen. As we look at the closer photo, we can see that the longer that these foreign objects are there, the body’s response is to start to begin to grow blood vessels to the area, so removing timely is important.  When talking about conjunctival foreign bodies, it’s important to understand the nature of the injury and when it occurred. And sometimes this needs to be referred out to an ophthalmologist to be removed because it may require incision as well as sutures to close the conjunctiva. This unfortunate gentleman got a stick to the eye while walking through the forest on a hike. Hopefully this has been a good refresher course. And remember, when in doubt, you can always send it out. This has been Cecelia Koetting with Optometry Advisor.