Foreign Body in the Eye

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

A foreign body in the eye refers to any object or material that enters the eye from outside the body, causing discomfort, pain, and potential damage to the ocular structures.

Aetiology

Common causes of foreign bodies in the eye include:

• Debris (e.g., dust, sand, wood chips)
• Metal fragments (e.g., from grinding or drilling)
• Insects or plant material
• Contact lens debris or misplacement

Pathophysiology

The entry of a foreign body into the eye can cause mechanical damage to the cornea, conjunctiva, or other ocular structures. This may lead to an inflammatory response, infection, or, in severe cases, penetration of the eye, resulting in more serious complications.

Risk Factors

• Occupations or activities involving exposure to debris or high-velocity particles
• Failure to use appropriate eye protection
• Contact lens wear
• Outdoor activities in windy or dusty environments

Signs and Symptoms

Common signs and symptoms of a foreign body in the eye include:

• Foreign body sensation
• Severe eye pain
• Tearing
• Redness of the eye
• Blurred vision
• Light sensitivity (photophobia)
• Blepharospasm (involuntary tight closure of the eyelids)

Investigations

• Clinical history and physical examination
• Fluorescein staining of the cornea to identify abrasions or foreign bodies
• Slit-lamp examination to assess the extent and location of the foreign body
• Eversion of the eyelid to check for retained foreign bodies
• Imaging (e.g., X-ray, CT scan) if a penetrating injury or intraocular foreign body is suspected

Management

Primary Care Management

• Removal of superficial foreign bodies: Using saline irrigation or a sterile cotton swab
• Topical antibiotics: To prevent infection (e.g., chloramphenicol ointment)
• Lubricating eye drops: To keep the eye moist and promote healing
• Pain management: Oral analgesics such as paracetamol or ibuprofen
• Immediate referral to emergency eye service: If any of the following conditions are met:
  • A suspected penetrating eye injury or intraocular foreign body is present
  • Significant orbital or peri-ocular trauma has occurred
  • A chemical injury has occurred — immediately irrigate the eye with copious irrigation fluid (such as lactated Ringer's solution, normal saline, or water if other irrigation solutions are not available) for 20-30 minutes and refer as an emergency to ophthalmology
  • A retained foreign body that cannot be removed safely in primary care is present
  • Foreign bodies composed of organic material (such as seeds, soil, insect scales or caterpillar setae) as these are associated with a higher risk of infection and complications
  • Foreign bodies in or near the centre of the cornea
  • Any of the following red flag clinical features are present:
    • Severe pain
    • Irregular, dilated or non-reactive pupils
    • Significant reduction in visual acuity
    • Hyphaema (blood in the anterior chamber) or hypopyon (pus in the anterior chamber)
    • Large or deep abrasions
    • Corneal opacity
    • Infection or corneal ulcer is suspected
    • They are unable to tolerate examination or foreign body removal in primary care
• Advise the person not to place pressure on the eye and to limit coughing or straining to prevent extrusion of intraocular contents.
• Do not remove foreign bodies that are visible and protruding out of the globe.
• Have a low threshold for referral of young children who may not be able to explain symptoms or are reluctant to open their eye for examination.

Specialist Management

• Removal of retained foreign bodies: Using specialised equipment under magnification
• Topical and oral antibiotics: To prevent or treat infection
• Topical cycloplegics: To reduce ciliary spasm and associated pain (e.g., cyclopentolate)
• Follow-up: Regular monitoring to ensure proper healing and to detect any complications such as infection or scarring
• Management of underlying conditions (e.g., dry eye) to prevent recurrence

References

1. NICE. (2024). Management of Foreign Body in the Eye. Retrieved from NICE
2. NHS. (2023). Foreign Body in the Eye. Retrieved from NHS
3. British Medical Journal (BMJ). (2022). Foreign Body in the Eye: Diagnosis and Management. Retrieved from BMJ
4. American Academy of Ophthalmology (AAO). (2021). Clinical Practice Guidelines: Foreign Body in the Eye. Retrieved from AAO

Back to Top