What is the preferred method of removal of corneal foreign bodies?
a. Removal with an 18-gauge needle
b. Removal with a moistened cotton-tipped swab
c. Removal with an optical burr
d. Outpatient removal within one week by ophthalmologist
A great variety of intraocular foreign bodies have been described, including metal fragments, wood, plastic, and others. Once determined that the injury to the eye is a simple foreign body and resultant corneal abrasion, removal of the foreign body should be performed under slit lamp visualization to provide consistent and stable removal of the offending irritant.
Corneal foreign bodies can often be safely removed in the ED. An initial attempt to remove an irritant from the pediatric eye may be performed with a moistened cotton-tipped swab. If this effort is unsuccessful, the use of a needle is indicated to remove the foreign body. It is important to reassure the patient and parents that the needle does not go into the eye, but merely rests on the surface. Attach a standard 18-gauge needle to a 3 mL syringe for stability. Some prefer to bend the needle shaft 30° to facilitate the approach to the eye. The foreign body can then be gently lifted off the surface of the cornea. Once the foreign body is dislodged, use a moist cotton swab to remove it from the surface of the eye, if necessary. If a rust ring remains following removal of a metallic foreign body, this may also be removed in the ED with either the needle or a burr. It is also acceptable to schedule ophthalmology follow up for removal within 24–48 hours.
Following foreign body removal, reexamine the eye for signs of ocular penetration. Pay particular attention for Seidel's sign, a leak of fluid that appears to be a dark stream of fluid on top of a green fluorescein background. After the foreign body is removed and signs of ocular perforation are excluded, the injury may be treated as a simple corneal abrasion
Answer: B (as we all know a moistened cotton-tipped swab is rarely successful, however)
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