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Subject: Conjunctival and Corneal Foreign Object Removal
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A Snellen chart or
equivalent visual acuity chart can be obtained from Premier
Medical, P. O. Box 4132, Kent, WA 98032. Phone: 1-800-955-2774.
Web site: http://premieremedical.safeshopper.com
ophthalmic anesthetic (e.g., tetracaine [Pontocaine] or
proparacaine [Opthetic]), cycloplegic drops, topical antibiotics
ointment (e.g., erythromycin [Ilotycin], bacitracin, or sulfacetamide).
loupes, and Wood’s lights may be ordered from medical
supply companies. Fluorescein strips may be ordered from
cotton-tipped swabs, hypodermic needle (26 gauge), sterile
water, bag of normal saline with IV drip tubing,
Small, conjunctival, or
corneal foreign bodies embedded <24 hours
Foreign bodies embedded
in the cornea for >24 hours (i.e., risk of infection)
bodies, which may cause a rust ring (relative
Deeply or centrally
embedded foreign bodies (i.e., ophthalmologic referral)
Possible acid or alkali
contamination of the eye (i.e., ophthalmologic emergency)
Ruptured globe (i.e.,
opacification, abnormal anterior chamber examination, or
irregularity of the pupil (i.e., possible ruptured globe, which
is an ophthalmologic emergency)
Signs or symptoms of
infection (i.e., ophthalmologic referral)
PEARL: A wire eye speculum may be used but
usually is not available in primary care offices.
PITFALL: Vertical scratches on the cornea
may indicate a foreign body embedded in the upper lid,
necessitating eyelid eversion and examination with a
PITFALL: Putting drops directly on a
scratched cornea can be very painful.
PITFALL: Never use force or rub the cornea
because this can produce pain, damage the epithelium, and
cause deeper corneal injuries.
PITFALL: If the object cannot be readily
removed, refer the patient for removal under slit lamp by an
PITFALL: If any residual corneal rust is
found, immediately refer the patient to an ophthalmologist
because rust is toxic to the corneal epithelium.
Perforation of the