Ocular foreign bodyMANAGEMENT

OPHTHALMOLOGIC PRESENTATIONS · 12 SECTIONS

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536 items

☷ Legend

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Cardiovascular Presentations66▾

Respiratory Presentations47▾

Neurological Presentations77▾

Gastrointestinal Presentations63▾

Genitourinary and Reproductive Presentations44▾

Infectious Disease Presentations146▾

Trauma Presentations88▾

Toxicologic Presentations67▾

Psychiatric Presentations25▾

Musculoskeletal and Rheumatologic Presentations89▾

Dermatology Presentations21▾

Environmental and Exposure Presentations26▾

Hematologic and Oncologic Presentations30▾

Pediatric-Specific Presentations13▾

Endocrine and Metabolic Presentations42▾

ENT and Maxillofacial Presentations21▾

Ophthalmologic Presentations15▾

Acute angle-closure glaucoma Central retinal artery occlusion Central Retinal Vein Occlusion Chemical eye injury Corneal abrasion Corneal ulcer Globe rupture Hyphema Iritis-Uveitis Ocular foreign body Optic Neuritis Orbital cellulitis Orbital Floor Fracture (Blowout)Retinal detachment Vitreous Hemorrhage

Obstetric Presentations17▾

Systemic and Miscellaneous Presentations15▾

01Approach to the Critical Patient/attcp59

Immediate priorities

›Time-critical threats

›Open globe concern

›Rigid eye shield

›Avoid pressure patch

›Intraocular foreign body concern

›Emergent ophthalmology

›CT orbits without contrast

›Chemical exposure concern

›Irrigation before full exam

›pH normalization target

›Severe vision loss

›Emergent ophthalmology

›Treat as globe-threatening until proven otherwise

›Analgesia and antiemesis

›Pain control to permit exam

›Oral acetaminophen

›Oral NSAID if appropriate

›If nausea or vomiting

›Antiemetic to reduce Valsalva

›Escalate if repeated emesis

›Eye protection and precautions

›If open globe suspected

›Stop exam after key findings

›NPO status

›If contact lens in place

›Immediate removal

›Pseudomonas coverage planning

›Early consultation triggers

›Ophthalmology now triggers

›Positive Seidel test

›Embedded or penetrating foreign body

›Hyphema

›Irregular or peaked pupil

›Markedly decreased visual acuity

›Suspected intraocular foreign body mechanism

›Unable to complete exam due to pain or agitation

Key concepts

›Foreign body categories

›Superficial conjunctival foreign body

›Often irrigation-responsive

›Low risk if no corneal involvement

›Corneal foreign body

›Abrasion and infection risk

›Metallic rust ring risk

›Intraocular foreign body

›Open globe until proven otherwise

›Endophthalmitis risk

›Orbital foreign body

›Associated ocular injury risk

›Sinus or intracranial extension risk

›High-risk mechanisms

›High-velocity metal on metal

›Grinding

›Hammering

›Explosive or blast mechanism

›Multiple fragments possible

›Organic contamination possible

›Vegetative material exposure

›Fungal keratitis risk

›Deeper infection risk

02History/hx62

Mechanism and exposure

›Event details

›Time since injury

›< 6 hours

›≥ 6 hours

›Environment

›Worksite

›Home

›Outdoor wind or debris

›Eye protection use

›None

›Partial

›Proper goggles or shield

›Suspected material

›Metal

›Grinding or drilling

›Rust ring likelihood

›Organic

›Wood

›Plant material

›Glass

›Windshield or window

›Blast fragments

›Sand or dirt

›Conjunctival trapping risk

›Multiple particles risk

Symptoms and risk modifiers

›Symptom profile

›Foreign body sensation

›Worse with blinking

›Localized scratch sensation

›Pain severity

›Mild to moderate

›Severe deep pain

›Photophobia

›Suggests corneal abrasion or uveitis

›If severe consider traumatic iritis

›Tearing and blepharospasm

›Limits exam

›Suggests corneal epithelial injury

›Vision change

›Blurred vision

›Visual field defect

›Contact lens history

›Current wear at time of injury

›Pseudomonas risk

›Keratitis risk

›Overnight wear

›Higher microbial keratitis risk

›Lower threshold for ophthalmology

›Tetanus status

›Up-to-date

›No booster needed for superficial non-penetrating injury

›Booster if penetrating injury criteria met

›Not up-to-date

›Booster for penetrating injury or intraocular foreign body concern

›Immune globulin per routine tetanus guidance when indicated

›Red flag history

›High-velocity projectile

›Treat as intraocular foreign body risk

›Imaging threshold lowered

›Prior ocular surgery

›Increased rupture risk

›Altered anatomy complicating exam

03Physical Exam/exam59

Visual function and pupillary assessment

›Visual assessment

›Visual acuity each eye

›Document baseline comparison

›If unable then pinhole attempt

›Visual fields confrontation

›Peripheral deficit suggests posterior segment injury

›Central deficit suggests corneal axis involvement

›Pupils and afferent pathway

›Size and shape

›Peaked or teardrop pupil suggests open globe

›Anisocoria new after trauma concern

›Reactivity

›Reduced reactivity concern

›Relative afferent pupillary defect concern

External, lids, conjunctiva, cornea

›External inspection

›Periorbital trauma

›Lacerations

›Ecchymosis or edema

›Lid eversion

›Upper tarsal foreign body

›Subtarsal particles

›Slit lamp findings

›Conjunctiva

›Injection pattern

›Subconjunctival hemorrhage

›Cornea

›Foreign body location

›Depth estimate

›Central visual axis involvement

›Anterior chamber

›Cells and flare

›Hyphema

›Iris and lens

›Iridodialysis concern

›Traumatic cataract concern

Fluorescein and globe integrity

›Fluorescein staining

›Abrasion pattern

›Linear vertical abrasion suggests subtarsal foreign body

›Diffuse punctate pattern suggests dry eye or exposure

›Epithelial defect size

›Small

›Large

›Seidel test

›Positive finding

›Aqueous leak indicator

›Open globe until proven otherwise

›If positive

›Stop manipulation and removal attempts

›Rigid shield and urgent ophthalmology

PITFALLS

›Common misses

›Failure to evert lid

›Persistent symptoms after removal

›Recurrent linear abrasions

›Tonometry in suspected open globe

›Contraindicated due to extrusion risk

›Defer until globe integrity confirmed

›Ocular ultrasound with open globe concern

›Avoid due to pressure risk

›Use CT first when available

04Differential Diagnosis/ddx44

Vision-threatening ocular trauma

›Globe-threatening conditions

›Open globe injury

›Penetrating injury with foreign body ICD-10 S05.5

›Peaked pupil or uveal prolapse

›Intraocular foreign body

›Often occult with high-velocity mechanism

›Endophthalmitis risk

›Corneal laceration

›Seidel positive leak

›Irregular anterior chamber depth

›Hyphema

›Photophobia and blurred vision

›Elevated intraocular pressure risk

›Orbit-threatening conditions

›Orbital foreign body

›Sinus extension risk

›Intracranial extension risk

›Orbital fracture with entrapment

›Diplopia with gaze limitation

›Oculocardiac reflex concern

Mimics and related diagnoses

›Surface disease mimics

›Corneal abrasion without foreign body ICD-10 S05.0

›Fluorescein uptake without retained particle

›Pain with blinking

›Infectious keratitis

›Contact lens wearer

›Corneal infiltrate or ulcer

›Conjunctivitis

›Diffuse injection

›Discharge pattern

›Inflammatory conditions

›Traumatic iritis

›Consensual photophobia

›Cells and flare

›Acute angle closure glaucoma

›Mid-dilated pupil

›Hazy cornea and severe headache

›Coding for superficial foreign body

›Foreign body in cornea ICD-10 T15.0

›Laterality and encounter extension codes as applicable

›Separate corneal abrasion coding per documentation rules

›Foreign body in conjunctival sac ICD-10 T15.1

›Often resolved with irrigation

›Eversion needed to confirm clearance

05Laboratory Tests/lt18

Routine testing

›No routine labs for uncomplicated superficial foreign body

›Normal vitals and isolated ocular complaint

›No systemic workup

›Focused ocular assessment

›If topical therapy only

›No baseline labs needed

›Follow-up planning prioritized

Infection and systemic concern

›If suspected infectious keratitis

›Ophthalmology-directed corneal culture

›Contact lens with ulcer or infiltrate

›Vegetative exposure with worsening pain

›If systemic signs present

›Complete blood count for systemic infection concern

›Blood cultures for severe systemic infection concern

›If open globe or operative pathway

›Preoperative testing per local protocol

›Type and screen if major trauma context

›Coagulation studies if anticoagulant use or bleeding concern

06Diagnostic Tests/dt40

Scoring Systems

›Ocular injury classification and prognosis tools

›Birmingham Eye Trauma Terminology

›Penetrating injury definition

›Intraocular foreign body definition

›Ocular Trauma Score

›Prognostic stratification after open globe injury

›Initial visual acuity contribution

›Pediatric Ocular Trauma Score

›Pediatric prognostic framework

›Specialist use in severe trauma pathways

MRI

›MRI considerations

›Metallic foreign body concern

›Contraindicated due to movement risk

›Use CT first

›Non-metallic suspected foreign body

›Consider only after CT and ophthalmology input

›Consider for suspected wooden foreign body when CT nondiagnostic

›CT orbits without contrast

›Indications

›High-velocity mechanism

›Suspected intraocular foreign body

›Technique

›Thin cuts through orbits

›Axial and coronal reconstructions

›Interpretation targets

›Intraocular foreign body presence

›Globe contour abnormality

›Limitations

›Small organic foreign body detection limits

›Clinical correlation required

Ultrasound

›Point-of-care ocular ultrasound

›Indications

›Trauma with vision change

›Foreign body evaluation adjunct

›Contraindications

›Suspected open globe due to pressure risk

›Positive Seidel test

›Findings and limitations

›Posterior segment pathology detection

›Foreign body detection variable by material and location

07Disposition/dispo36

Consultation and level of care

›Ophthalmology emergent

›Open globe signs

›Positive Seidel test

›Uveal prolapse or peaked pupil

›Suspected intraocular foreign body

›High-velocity mechanism

›CT evidence of foreign body

›Corneal ulcer or infiltrate

›Contact lens wearer with focal opacity

›Worsening pain or photophobia

›Hyphema

›Layering blood in anterior chamber

›Elevated intraocular pressure concern

›Ophthalmology urgent within 24 hours

›Incomplete foreign body removal

›Deep stromal fragment

›Central visual axis involvement

›Rust ring

›Symptomatic or central

›Need for specialized debridement

›Persistent symptoms after removal

›Lid foreign body concern

›Missed fragment concern

Discharge criteria

›Discharge eligible

›Foreign body fully removed

›No embedded fragment seen

›Symptoms improved

›Globe integrity confirmed

›Seidel negative

›No signs of open globe

›Vision acceptable

›Visual acuity at baseline or near baseline

›No new visual field deficit

›Follow-up arranged

›24 to 48 hour recheck

›Earlier if contact lens wearer

08Treatment/t80

Removal and procedural approach

›Superficial foreign body removal strategy

›Irrigation first line

›Sterile saline irrigation

›Recheck with lid eversion

›If adherent conjunctival or corneal foreign body

›Slit lamp removal preferred

›Avoid manipulation if suspected full-thickness penetration

›Rust ring management

›Partial removal acceptable if deep

›Ophthalmology follow-up for residual ring

Medications and symptom control

›Topical anesthesia for exam and removal

›Proparacaine 0.5 percent ophthalmic

›1 to 2 drops in affected eye

›Repeat sparingly during procedure

›Avoid outpatient prescription due to corneal toxicity risk

›Tetracaine 0.5 percent ophthalmic

›1 to 2 drops in affected eye

›Procedure-only use

›Avoid prolonged use

›Topical antibiotic prophylaxis after corneal foreign body

›Non-contact lens wearer options

›Erythromycin ophthalmic ointment

›0.5 inch ribbon 4 times daily

›Typical course 3 to 5 days

›Continue until symptom-free 24 hours

›Polymyxin B trimethoprim drops

›1 drop 4 times daily

›Typical course 3 to 5 days

›Use if ointment not tolerated

›Contact lens wearer options

›Fluoroquinolone drops with Pseudomonas coverage

›Ciprofloxacin 0.3 percent 1 to 2 drops 4 times daily

›Typical course 3 to 5 days

›No contact lens until fully healed

›Ofloxacin 0.3 percent 1 to 2 drops 4 times daily

›Typical course 3 to 5 days

›Low threshold ophthalmology if pain persists

›Cycloplegia for significant photophobia or traumatic iritis concern

›Cyclopentolate 1 percent

›1 drop up to 3 times daily

›Avoid in narrow angle risk

›Reassess if pain worsens

›Pain control

›Oral acetaminophen

›10 to 15 mg per kg per dose pediatrics

›Maximum per local guidance

›Consider weight-based scheduling

›650 to 1000 mg adults

›Maximum daily dose per local guidance

›Hepatic disease caution

›Oral ibuprofen

›10 mg per kg per dose pediatrics

›Maximum per local guidance

›Renal disease caution

›400 to 600 mg adults

›Typical interval 6 to 8 hours

›GI bleed risk discussion

›Lubrication

›Preservative-free artificial tears

›1 to 2 drops as needed

›Comfort and epithelial healing support

›Avoid contaminated bottles

Open globe or intraocular foreign body pathway

›Globe protection and escalation

›Rigid shield and no pressure

›No eyelid retraction forceful maneuvers

›No foreign body removal attempts

›NPO and operative readiness

›Antiemetic for emesis prevention

›Analgesia escalation as needed

›Antibiotics for open globe or intraocular foreign body concern

›Broad-spectrum systemic antibiotics per ophthalmology or protocol

›Gram-positive and gram-negative coverage

›Consider vancomycin plus ceftazidime protocol in severe open globe pathways

›Dose adjust for renal function and pediatrics

›Tetanus prophylaxis

›Penetrating injury or intraocular foreign body

›Booster if not up-to-date

›Immune globulin if indicated by immunization history

›Superficial corneal foreign body without anterior chamber penetration

›No tetanus prophylaxis routinely needed

09Special Populations/sp43

Pregnancy

›Medication considerations

›Topical antibiotics

›Erythromycin generally preferred when feasible

›Avoid systemic agents unless globe-threatening pathway

›Analgesia

›Acetaminophen preferred

›NSAID use avoided in later pregnancy per obstetric guidance

›Imaging considerations

›CT orbits when intraocular foreign body concern

›Maternal vision threat prioritization

›Shielding per radiology protocol

›MRI avoidance if metallic foreign body possible

›Material uncertainty treated as metallic until excluded

›Ophthalmology input before MRI

Geriatric

›Higher risk features

›Anticoagulant or antiplatelet use

›Hyphema bleeding risk

›Lower threshold for imaging and consult

›Ocular surface disease

›Dry eye complicating symptoms

›Slower epithelial healing

›Medication tolerability

›Cycloplegics

›Urinary retention risk

›Delirium risk in sensitive patients

›NSAIDs

›Renal function consideration

›GI bleed risk consideration

Pediatrics

›Exam challenges

›Limited cooperation

›Early analgesia strategy

›Child life support when available

›Lid eversion difficulty

›Missed subtarsal foreign body risk

›Consider ophthalmology if exam incomplete

›Sedation considerations

›If removal needed and uncooperative

›Procedural sedation pathway per ED protocol

›Ophthalmology support if deep corneal foreign body

›Non-accidental injury awareness

›Inconsistent history

›Safeguarding escalation per policy

›Document findings carefully

10Background/b30

Epidemiology

›Frequency and settings

›Common ED presentation in occupational settings

›Metal grinding and drilling

›Lack of eye protection association

›Material patterns

›Metallic particles common in work injuries

›Organic material common in outdoor exposures

Pathophysiology

›Tissue response by location

›Conjunctival foreign body

›Mechanical irritation and inflammation

›Trapping in fornices and under lids

›Corneal foreign body

›Epithelial defect and nociceptor activation

›Infection risk from epithelial breach

›Metallic rust ring

›Oxidation reaction

›Corneal staining and inflammation

›Intraocular foreign body

›Penetration with entrance wound

›Endophthalmitis risk from contamination

Therapeutic Considerations

›Aftercare principles

›Antibiotic prophylaxis rationale

›Superinfection prevention in epithelial defects

›Higher risk with contact lens use

›Cycloplegia rationale

›Ciliary spasm reduction

›Photophobia relief

›Avoid outpatient topical anesthetics

›Corneal toxicity and delayed healing risk

›Masking of worsening symptoms risk

11Patient Discharge Instructions/pdi38

copy discharge instructions

›Eye care at home

›No rubbing or pressing on the eye

›Avoid contact lenses until cleared

›Avoid eye makeup until healed

›Antibiotic use as prescribed

›Complete course as directed

›Wash hands before drops or ointment

›Pain control options

›Acetaminophen as needed

›Ibuprofen as needed if safe

›Activity and safety

›Protective eyewear for future work

›Wraparound goggles for grinding or drilling

›Face shield for high-risk tasks

›Avoid swimming or hot tubs until healed

›Infection risk reduction

›Contact lens users higher risk

›Return to emergency care now

›Worsening pain

›Not improving within 24 hours

›New severe photophobia

›Vision changes

›New blurring

›New floaters or flashes

›New field loss

›Increasing redness or discharge

›Concern for infection

›Concern for corneal ulcer

›Persistent foreign body sensation

›Possible retained subtarsal foreign body

›Possible missed fragment

›Follow-up

›Recheck in 24 to 48 hours

›Confirm healing

›Confirm no retained foreign body

›Same-day ophthalmology if instructed

›Rust ring follow-up

›Deep corneal involvement follow-up

12References/r27

Clinical guidelines and core sources

›Guideline and reference set

›American Academy of Ophthalmology EyeNet

›Open globe injury assessment and eye shield guidance

›Tetanus prophylaxis not recommended for superficial corneal abrasions and foreign bodies without anterior chamber penetration

›ACEP Sonoguide ocular emergencies

›Ocular ultrasound indications include eye trauma and foreign body

›POCUS as adjunct in ocular complaints

›ACEP ultrasound guidelines policy statement

›Clinical ultrasound guidance includes foreign body applications

›Scope and training standards reference

›Evidence-based summaries and reviews

›StatPearls corneal foreign body

›Post-removal care with topical antibiotics and cycloplegics

›Complication monitoring and follow-up needs

›EyeWiki removal of corneal foreign bodies

›Rust ring formation timeline for iron foreign body

›Seidel testing after removal

›EyeWiki BETT

›Standard terminology definitions for penetrating injury and intraocular foreign body

›Communication standardization for ocular trauma

›Coding standards

›WHO ICD-10

›T15.0 foreign body in cornea

›T15.1 foreign body in conjunctival sac

›ICD-10-CM code reference for penetrating wound with foreign body

›S05.5 penetrating wound with foreign body of eyeball

›Exclusion of retained old intraocular foreign body codes

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed June 16, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.