Foreign Body in the Eye

Anything that gets in the eye is medically termed a foreign body. Depending on what gets into the eye, or how an injury occurred, a foreign body may scratch or pierce the eye may simply irritate the eye and go away with no long-term problem, or it could cause serious injury such as a corneal abrasion.

From the occasional eyelash that wanders uninvited into the eye to the high-speed impact of an ejected metal shard, one may find oneself with something in the eye (medically referred to as a foreign body). Depending on what it is and how the injury happened, the foreign body may pierce the eye and cause serious injury or it may simply go away with no long-term problem.

Most people realize that an eyelash in the eye does not require an evaluation by a doctor but that a metal shard in the eye would warrant a visit to your ophthalmologist (a medical doctor who specializes in eye care and surgery), particularly if it has penetrated beyond the superficial layers of the surface of the eye.

Many eye injuries can be prevented. Something in the eye (a foreign body) is most often the result of improper or no eye protection while working in an environment that exposes one to small flying debris.

• Sharp pain in the eye followed by burning, irritation, tearing, and redness
• Feeling that something is in the eye when moving the eye around while it is closed
• Scratching sensation over the eye when blinking
• Blurred vision or vision loss in the affected eye
• Bleeding into the white part of the eye, which can be either a conjunctival hemorrhage or a subconjunctival hemorrhage. (Sometimes, this is associated with a penetrating injury.)
• Blood layering in front of your iris, the colored area of the eye, and behind the cornea, the clear dome on the front of the eye (This is called hyphema and is often a sign of significant injury.)

Because of the specialized nature of eye examination equipment, a foreign body in the eye is usually handled best in an ophthalmologist's office. If an emergency department has the necessary equipment, an ophthalmologist may also see the patient in the emergency department. In some cases, a foreign body in the eye may be handled in an emergency department that has both a properly trained emergency physician and the appropriate equipment.

The most important aspect in deciding to seek medical attention has to do with one's own evaluation of the severity of the injury. A few guidelines should be followed in deciding to have the eyes evaluated. If one does not meet these guidelines, but is concerned that there may be significant damage, then it is always safer to be evaluated by an ophthalmologist or in a hospital's emergency department.

• All children with eye injuries should be evaluated, especially if they complain of any visual problems, scratching sensation, or pain or if the eye is red and has a discharge.
• Adults should seek medical attention for the following:
  • The patient feels something going into the eye after hitting metal on metal, such as hammering a nail.
  • The patient has removed the foreign body from the eye and continues to have a sensation that something is in the eye, or the patient continues to have pain and tearing after removal of the object.
  • The patient is unable to remove the foreign body from the eye.
  • The patient's vision is blurry or otherwise compromised (blind spots, seeing "stars").
  • The patient is bleeding from the eye or the area around the eye (including cuts to the eyelid or eyebrow).
  • Clear or bloody fluid is coming from the eyeball.

• The first part of an eye examination is to evaluate the vision for acuity (how well one sees).
• The next portion of the examination, usually only performed by an ophthalmologist or a doctor in the emergency department, is the slit lamp examination. While one sits in a chair with their chin on a support, the doctor shines a small slit of light into the eye and looks through a microscope. This helps the doctor to see the cornea, the iris, and the lens, and the fluid in the eye.
  • The doctor starts with a general examination of the visible portions of your eye. The eyelids, eyeball, and iris are examined.
  • During this part of the examination, the doctor looks to make sure that the pupil is symmetric and reacts properly to light, that there is no obvious injury to the eyeball, and that no visible foreign bodies are still in the eye.
  • The eye may be numbed with pain medicine, and a fluorescent dye may be applied to the eye. A blue light may be used to help look for scratches on the cornea or evidence of leaking aqueous fluid, which is the clear fluid that fills the front of the eyeball.
  • While the eye is numbed, a tonometer may be used to check the pressure in the eye.
  • The eyelid may be everted (turned inside out) with a cotton swab to get a better view of the underside of the eyelid.
• Depending on the severity of injury to the eye, the final portion of the examination involves dilating (enlarging) the pupil with eyedrops. Then, the inside of the eye and the retina can be evaluated to ensure that there are no foreign bodies inside the eyeball itself and that there is no damage to the retina.

• For scratches on the cornea (called corneal abrasions), the usual treatment is an antibiotic ointment and/or antibiotic eyedrops and pain medicine. If the abrasion is large (greater than 50% of the corneal surface), then it may also be treated with a patch.
• Any noted damage to the iris, the lens, or the retina requires immediate evaluation by an ophthalmologist and may or may not require surgery.
• A ruptured eyeball requires surgery by an ophthalmologist.
• If no other injury is noted, hyphema (blood in between the cornea and the iris) requires close follow-up care with an ophthalmologist.

• Keeping follow-up appointments is important. Follow-up care is necessary to ensure that the treatment prescribed is effective.
• Depending on the severity of the injury, follow-up care for re-evaluation should be in 1 to 2 days with an ophthalmologist.

One should be able to care for minor debris in the eye at home. If one has trouble removing something in the eye or if a larger or sharper object is involved, seek medical attention. If one is wearing a contact lens, it should be removed prior to trying to remove the foreign body. One should not put the contact lens back into the eye until the eye is completely healed.

• For minor foreign bodies, such as an eyelash, home care is usually adequate.
  • Begin by rinsing the eye with a saline solution (the same solution used to rinse contact lenses). Tap water or distilled water may be used if no saline solution is available. Water will effectively flush out the eye, but the chlorine in most tap water can cause varying levels of irritation. How one washes out the eye is less important than getting it washed out with great amounts of water.
    • A water fountain makes a great eye wash. Just lean over the fountain, turn on the water, and keep the eye open.
    • At a sink, stand over the sink, cup the hands, and put the face into the running water.
    • Hold a glass of water to the eye and tip the head back. Do this multiple times.
    • If one is near a shower, get in and put the eye under the running water.
    • If one is working outside, a garden hose running at a very modest flow will work.
  • If washing the eye is not successful, the object can usually be removed with the tip of a tissue or a cotton swab.
    • Pull back the eyelid by pulling down on the bottom edge of the lower lid or by pulling up on the upper edge of the upper lid.
    • Look up when evaluating for a foreign body under the lower lid.
    • Look down when evaluating for a foreign body under the upper lid. One will often need someone to help in this case.
    • Be very careful not to scrape the tissue or the cotton swab across the cornea, the clear dome over the iris.
• For larger foreign bodies or metal pieces, one should seek medical care, even if they are able to safely remove them at home.
  • If the foreign body is easily accessible and has not penetrated the eyeball, one may be able to remove it carefully with a cotton swab or a tissue.
  • If one has any question about penetration of the eye, do not remove the object without medical assistance.
  • If one cannot remove the object or if one continues to have the sensation that something is in the eye even after the debris is removed, they should seek medical care.
• After the foreign body is removed, the eye may be red and tearing.
• It is very important not to rub the eye or to apply any pressure to the eye. If one has punched a hole in the eye (called a ruptured globe or eyeball), one can do significant damage by pressing or rubbing your eye. This is especially true with small children who will rub their eyes to try to remove the debris.
• Do not put any pressure on the injured eye, because it could cause additional injury to the eye. Do not tape over or patch the eye with any pressure on the injured eye.

• Eye protection is the best prevention. Many eye injuries, especially high-speed impacts that may rupture the globe (eyeball), are usually devastating to the eye and could result in vision loss.
• Always wear eye protection when working in an environment where flying debris is likely.
• Eye protection should cover not only the front but also the side of the eyes. Regular sunglasses or corrective glasses are not sufficient eye protection when working in a high-risk environment. One should wear goggles or safety glasses with side shields.

• The prognosis for corneal abrasions, even large ones, is very good. Most corneal abrasions heal within 48 hours.
• The prognosis for other eye abnormalities is often much less favorable.
  • A ruptured globe (eyeball) often leads to total loss of vision, even with early intervention.
  • Retinal damage usually leads to permanent vision loss. Depending on the extent of the retinal damage, this vision loss could be partial or complete.
  • Depending on the nature of the injury and other associated injuries, damage to the iris may be repairable.
  • Lacerations to the tissues around the eye are often repairable but can lead to varying levels of facial disfigurement.