How to remove a corneal foreign body

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Remember – wash your hands before and after performing all procedures!

Indications

• To remove superficial material from the surface of the cornea, e.g., metal fragment.

You will need

• Slit lamp or magnification and torch
• Fluorescein strips
• Local anaesthetic drops
• Sterile No.21 gauge needle
• Sterile cotton buds
• Prescribed antibiotic eye drops or ointment
• Tape, two eye pads and bandage.

Preparation

• Position the patient comfortably with head supported – at the slit lamp, sitting in a chair or lying down

Method

• Instil local anaesthetic drops and fluorescein dye
• Ask the patient to look straight ahead,
  fix gaze and keep perfectly still
• With one hand, gently control the patient’s eyelids
• With the other hand, support the sterile needle with two fingers and the thumb
• Approach the cornea slowly with the bevel of the needle uppermost and horizontally ‘flat on’ to the cornea
• Gently lift off the foreign body (FB) from the corneal surface. Sometimes this is possible simply using a moist cotton bud and is safer practice in less skilled hands
• Check the patient’s eye, carefully everting the upper eyelid to ensure no FB’s remain – a corneal abrasion may be seen
• Instil antibiotic ointment and apply a firm eye dressing, using two pads and a bandage, for 24 hours.

If there is any resistance and the FB does not come off easily do not persist! The FB may be deeply embedded and this situation should be referred for further medical attention.

Finally

• Wipe needle with a swab to confirm removal of FB and show it to the patient – this will reassure him/her it has been removed
• Dispose of needle carefully in an appropriate container