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A corneal foreign body can cause eye pain and loss of vision. Patients with a corneal foreign body usually present acutely with discomfort, photophobia, decreased vision, copious tearing, discharge, blepharospasm, or conjunctival hyperemia. However, the onset of these symptoms can be insidious, particularly in the absence of obvious trauma. A corneal foreign body may not always lead to reduced visual acuity; however, if not treated promptly, infection and tissue necrosis may ensue. This activity reviews the best practices for safely removing a corneal foreign body and describes the appropriate patient education and aftercare. The activity also examines the role of the interprofessional healthcare team in reducing the risk of sight-threatening complications for patients with corneal foreign bodies. Objectives: Identify patients at risk for a corneal foreign body based on clinical history. Apply best practices in the systematic evaluation of the ocular structures in order to definitively locate and potentially remove corneal foreign bodies. Undertake the requisite measures when an intraocular foreign body is suspected. Apply effective interprofessional team strategies for improving care coordination and communication to advance the removal of corneal foreign bodies and improve patient outcomes. Access free multiple choice questions on this topic.

Patients with corneal abrasions and foreign bodies commonly present to emergency departments, urgent care centers, primary care, and eye care providers.[1][2][3] The cornea is the most richly innervated tissue in the body.[4] Patients with corneal foreign bodies may report multiple ocular symptoms, including pain, photophobia, decreased vision, copious tearing, discharge, blepharospasm, and conjunctival hyperemia. Typically the event has an acute, easily identified onset. Corneal foreign bodies are often acquired obscurely and suspected only after mild ocular symptoms persist. Patients frequently report that the foreign body was lodged in the eye while outside or coincidentally while working in the yard or on a home improvement project. Perhaps more worrisome are injuries that involve the high-velocity mechanics associated with hammering, grinding, and drilling metals. The cornea is crucial for focusing light on the retina, allowing functional vision. As much as 67% of the eye's focusing power is derived from the cornea. A corneal injury will cause physical and functional discomfort. Subsequent corneal edema leads to photophobia and decreased visual acuity. Corneal scarring or irregularities may occur when objects are deeply embedded, resulting in significant vision disruption.[5] The cornea is essential for physically protecting the eye's internal structures from external elements.[6] The dense, bony orbital structures encompassing the eye also help to protect the ocular surface. To a greater extent, the blinking of eyelids and lashes and the formation of reflex tears attenuate the accumulation of foreign matter on the cornea. Of utmost concern is the potential for intraocular penetration, which may lead to devastating consequences, including endophthalmitis or retinal detachment.[7] Corneal foreign bodies can be acquired during blunt or penetrating trauma. Associated traumatic injuries may include lid abrasions or tears, scleral tears, iridodialysis, traumatic mydriasis, relative afferent pupillary defects, anterior capsular tears, traumatic or rosette cataract, cortical matter disturbance, zonular dialysis, and vitreous prolapse. The posterior segment injuries can manifest as retinal tears or detachment, choroidal detachment, vitritis, and intermediate or panuveitis.[8]

There should be a concern for potential complications if the patient does not report that their status is stable or improving. Evaluation of the ocular surface should be repeated 24 hours after corneal FB removal assessing for additional foreign bodies, nonhealing defects, or ulceration. Seidel testing should be repeated, and the anterior chamber should be reevaluated for shallowing, pupillary disfigurement, lenticular opacities, hyphema, hypopyon, or increased cells and flare.[44] Various complications of corneal FB injury include the following: Persistent conjunctivitis Nonhealing epithelial defect Corneal infiltrates, scarring, thinning, or perforation Rust ring formation Secondary glaucoma Anterior uveitis Iridodialysis Traumatic mydriasis Angle recession with subsequent glaucoma Anterior and posterior synechiae Anterior and posterior capsular tear or rupture Traumatic cataract Zonular dialysis Vitreous prolapse Retinal tears or incarceration of foreign bodies Retinal or choroidal detachment

When counseling patients, the healthcare team should reinforce the need for protective eyewear to diminish the risk of ocular trauma. Evidence of prior corneal scarring suggests previous injuries due to similar past events. Occupational settings, hobbies, and environmental factors may contribute to eye injuries. Any monocularly functioning patients should be prescribed full-time protective eyewear and strongly encouraged to use it to protect their only seeing eye.[46] Patient outcomes are improved when the team can rule out the signs of FB intraocular penetration. The team must ensure that a careful slit lamp exam and a dilated fundus exam are done promptly.[47] The nursing team, allied health staff, and interprofessional support framework play a key role in recruiting the emergency corneal foreign patients to the clinic, making the patient comfortable, assisting the patient with the slit lamp and operating room for foreign body removal, explaining the medications and counseling regarding natural course of the pathology, associated complications and the need for follow up.[48][49]