Hello again from the Emergency Procedures team,
Next up…removing foreign bodies from the eye
So, without further ado…here is the video
The video looks great but I’m not sure I can be bothered lifting my finger to download on the app store…tell me something interesting about foreign body removal.
Fair enough…. we understand, you are a busy!
Did you know that using a bigger needle is safer than using a smaller one to remove corneal foreign bodies. It’s harder to penetrate the tough cornea with a big needle.
Also, have you ever thought about the actual technique of FB removal.
Although scraping the foreign body off and removing some conjunctiva is ok, ideally you press the non-cutting flat of the needle bevel against the eye, depressing the eye surface, then slide the needle tip under the foreign body with the bevel and flick off the object without extra conjunctiva damage.
What if I’m scared of using a needle on a patient’s eye?
You can use an eye burr if your department has one, but honestly with a little practise everyone can use a needle and it causes less of a conjunctival defect.
If you are nervous about approaching the eye with a needle tip you can use a haemostat to bend the tip of the needle away from the eye. This mean you are removing the object with a tiny spoon rather than a sharp point.
When learning to use the needle its useful to practise on the slit lamp with an object taped into position and spend 10 minutes getting comfortable with the technique.
Is there anyone I shouldn’t remove an ocular FB from in the ED?
The only absolute contraindication is a penetrating eye injury which needs IV antibiotics and ophthalmology review. These guys may need a vitrectomy to remove the penetrating object.
Assessing to exclude a penetrating injury is your first task.
Ok, now let’s pretend I’m a pro…tell me some advanced bit of technique
Well, advanced technique is not necessary, it’s a simple task that just needs practise.
However, one aspect we learnt was that with an angled light beam you can assess the depth of corneal penetration of a FB in a way that cannot be seen with a perpendicular light beam
Can you confirm that giving local anaesthetic to take home is contraindicated and I’m a bad person if I give the patient the rest of the drops to take home?
Thinking here is slowly evolving.
The best evidence (see discussion and references) suggests that sending people home with 1.5 ml of anaesthetic is safe. However, expert opinion is that this is not often that helpful. Usually most of the pain is relieved worth FB removal and the conjunctiva also heals overnight usually and the local only lasts 20 mins after application.
Just like mydriatics if people have severe pain, you can consider it but it’s not routinely necessary
I’ve spotted an improvement that could be made to your video and guide?
Don’t be shy, let us know! Drop us a line