I think I have got something in my eye Foreign bodies in the eye Lin Khoo, Aug 2023 Ophthalmology registrar Aberdeen Royal Infirmary Getting the story 1. When and what were they doing when it happened? Is this foreign body of a lowhigh
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Presentation Transcript
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I think I have got something in my eye Foreign bodies in the eye
Lin Khoo, Aug 2023
Ophthalmology registrar
Aberdeen Royal Infirmary<br>
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Getting the story 1. When and what were they doing when it happened?
Is this foreign body of a low/high velocity
Low velocity – conjunctiva, under lid, cornea
Seed/sand/grit
High velocity – enter the globe/orbit
Hammering/ chiseling/high speed machinery – metal/stone/sharp glass
Nature of foreign body – dust, wood, metal, glass
‘Lost’ contact lens
Were they wearing protective eye goggles (provided or not)/spectacles/contact lenses<br>
03
Getting the story 2. How symptomatic?
Superficial not involving the cornea – discomfort not acute pain
Cornea involved – light sensitivity, screwing up eyelids, more intense pain, vision ok
Intraocular involvement, vision much worse
3. POHx
‘Lost’ contact lens
Do they usually wear spectacles/contact lenses
4. PMHx; DHx, SHx<br>
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Having a look VA – Snellen
Numbing drops (proxymetacaine/oxybuprocaine) – seconds to work
Front to back approach
Lids and conjunctiva - evert upper eyelids, check lower fornixes<br>
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Having a look Cornea
Fluorescein – linear abrasions (FB hiding under eyelid and scratching cornea when blinking), and epithelial defects<br>
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Having a look Anterior chamber – shallow? Streaming of fluorescein away from corneal laceration – leakage of aqueous fluid though corneal perforation
Corneal laceration that's seidel positive (Video) - TimRoot.com
Blood in anterior chamber?<br>
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Having a look Iris – teardrop shaped pupil (apex points to area of concern)
Further investigate with CT, NOT MRI (think metal FB)<br>
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What should you do? Lids/conj foreign body Remove with cotton bud
Chloramphenicol ointment QDS for 1/52<br>
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What should you do? Cornea foreign body Removal of foreign body with needle
Foreign body removed from cornea with a needle (Video) - TimRoot.com
Chloramphenicol ointment QDS 1/52<br>
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What should you do? Anterior chamber – aqueous leakage, blood in anterior chamber
Iris changes - teardrop shaped pupil
CT showing intraocular foreign body Protect the eye – shield NOT pad
Intraocular foreign body - Tetanus booster + antibiotics (Ciprofloxacin 750mg BD)
Keep NBM
Do not put other drops/ointment in eye
Refer to Ophthalmology<br>
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Mr. A - Hx taking 74 M
3/7 ago, metal grinding and felt something going into LE
Not wearing eye protection goggles then
Since event, vision no change but LE feels irritated and stingy<br>
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Mr. A - Hx taking POHx: R cataract surgery
PMHx: HTN, Hypercholesterolaemia
DHx: Adverse reaction to Ramipril and Simvastatin. On Candesartan, Ezetimibe, Inhalers, Omeprazole
SHx: Farmer. Drives<br>
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Mr. A – O/E Visual acuity RE 6/4.8; LE 6/15 improving to 6/9.5 with pinhole<br>
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Mr. A – O/E LE red. Nil on lid eversion. Metal FB at 4 o'clock cornea limbal area.
Anterior chamber deep with no fluorescein streaming away from area of corneal laceration. No blood in anterior chamber
Normal iris shape<br>
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Mr. A - Tx Remove metal FB with 25G needle on slit lamp
Chloramphenicol ointment QDS for 1/52<br>
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Main learning points Good history regarding mechanism of injury is crucial
Evert the eyelid
Fluorescein
High velocity, poor VA, anterior chamber changes, iris changes – think possibility of intraocular.
CT imaging
Tetanus booster
Antibiotics<br>
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Main learning points<br>
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References 1) Oxford Handbook of Ophthalmology. 4th edn (2014). OXFORD University Press.
2) Videos – TimRoot.com<br>