Foreign Bodies in the Eyelid
Foreign bodies in the eyelid are commonly seen in blast injuries, where the eyelid may be embedded with fine particles such as gunpowder residue, dust, and sand. Larger foreign bodies can be removed with forceps.
Foreign Bodies in the Conjunctiva
Frequently observed foreign bodies include dust and coal particles, often located in the tarsal sulcus, fornices, or plica semilunaris. These foreign bodies can cause irritation symptoms by rubbing against the cornea. Removal can be achieved by wiping with sterile, moistened cotton swabs after applying a topical anesthetic, or by flushing the conjunctival sac. Antibiotic eye drops are commonly applied after foreign body removal.
Foreign Bodies in the Cornea
Common substances include iron and coal particles, which cause significant irritation symptoms, such as sharp pain, photophobia, tearing, and blepharospasm.
Figure 1 Corneal foreign body
A metallic fragment is embedded in the corneal stroma of the left eye, with associated corneal infiltration and rust stain formation (A: diffuse illumination; B: slit beam image).
Metallic foreign bodies (e.g., iron) may lead to rust stain formation.
Plant-based foreign bodies have a higher likelihood of causing infections.
Management
Superficial corneal foreign bodies can be removed using saline-moistened cotton swabs under topical anesthesia. Deeper foreign bodies may require removal with a sterile injection needle. Rust stains, if present, should be scraped off as thoroughly as possible in a single procedure. Multiple foreign bodies may be removed in stages—superficial and exposed ones are addressed first, while deeper bodies are temporarily left untreated. For large foreign bodies that have partially penetrated the cornea and entered the anterior chamber, microsurgical removal is necessary, with corneal wound suturing performed if required. Strict sterile techniques must be maintained during the removal procedure to avoid the risk of inducing purulent corneal ulcers. Following foreign body extraction, antibiotic eye drops or ointment should be applied.
Foreign Bodies in the Orbit
Common orbital foreign bodies include metallic fragments, airgun pellets, or wood and bamboo splinters. Symptoms may include localized swelling and pain. If purulent infection occurs, complications such as orbital cellulitis or sinus tract formation may arise. Metallic foreign bodies in the orbit are often encapsulated by soft tissue and may not require removal unless specific conditions are present. Indications for surgical removal include the following:
- Communication between the orbit and nasal sinuses or cranial cavity caused by the foreign body.
- Persistent tissue reaction or delayed wound healing due to the foreign body.
- Large foreign bodies with rough surfaces that pose a potential risk to the optic nerve or other critical structures in proximity.
- Copper-based or plant-based foreign bodies.