Quick question for you Ophthalmologists. I'm an ED doc about to go out in practice. Every so often I get the guy that was cutting wood, welding, ect. and has a corneal foreign body. No perforation or open globe but a simple corneal foreign body. I seem to not be comfortable with these. First I have a tremor and seem to shake a bit when getting close to the cornea. Second I cannot seem to get my patients to cooperate the minute I get close to trying to take these out. I've tried coming in from the side with the needle, obviously tetracaine or burring it out; but between my tremor and patients cooperation these are the most frustrating when they should be simple dispo's. So my question is would you be bothered for f/u next day or two to remove these? If so what should I do to get these damn things out. Obviously in the Optho chair their much more relaxed and don't pull away (kidding).
The Ocular Foreign Body
- Thread starter EMDOC17
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I personally would rather remove the foreign body myself than have the ED struggle with it, especially if it is central. In my experience non-ophthalmologists have a tendency to be more aggressive with these and if you're going thru Bowmans, you will be leaving a scar. That said, it's always great when the ED can get them out 
A few tips:
1. try to irrigate first. A little saline in a syringe won't do any damage and occasionally does the trick. If that fails, a moistened cotton tipped applicator is another safe alternative.
2. I would only consider a burr to get any remaining rust ring after the foreign body is out, never to remove the metal. I actually rarely use burrs because rust rings tend to work their way out on their own over time and as above, less tissue removed = less scarring, especially centrally.
3. Have your nurse hold the patients head in the slit lamp.
4. Having steady hands is less about actual steady hands and more about positioning and bracing yourself. Make sure your elbow is supported at the slit lamp and not floating in the air. Brace your pinky and ring finger against the patients cheek. This not only steadies your hand but if the patient moves, your hand, and the needle with move with their eye.
5. My patients are usually pretty cooperative for this. If they smell fear you're done for. Make sure you're coming off as confident.
6. Sublingual timolol. For you, not the patient.
A few tips:
1. try to irrigate first. A little saline in a syringe won't do any damage and occasionally does the trick. If that fails, a moistened cotton tipped applicator is another safe alternative.
2. I would only consider a burr to get any remaining rust ring after the foreign body is out, never to remove the metal. I actually rarely use burrs because rust rings tend to work their way out on their own over time and as above, less tissue removed = less scarring, especially centrally.
3. Have your nurse hold the patients head in the slit lamp.
4. Having steady hands is less about actual steady hands and more about positioning and bracing yourself. Make sure your elbow is supported at the slit lamp and not floating in the air. Brace your pinky and ring finger against the patients cheek. This not only steadies your hand but if the patient moves, your hand, and the needle with move with their eye.
5. My patients are usually pretty cooperative for this. If they smell fear you're done for. Make sure you're coming off as confident.
6. Sublingual timolol. For you, not the patient.
Thanks KWR I appreciate it. One thing though. The rust ring seems like these need to be removed in 24 hours and not when I see them. Should I do 24 hr follow up with ophthalmology or in the ED to remove these?
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Assuming it's just a superficial foreign body with intact underlying cornea and no other injuries, topical antibiotics and next day follow up would be appropriate treatment for a rust ring that remains after FB removal. If you can safely get it all yourself that's great too. I prefer seeing patients in my clinic over the ED whenever possible because I have all of my equipment and my own staff. Do whatever works best for you and your local ophthalmologist but I think most of us feel better equipped to treat the vast majority of patients in our clinics.
