What is a foreign object in the eye?

Highlights

1.     A foreign object in the eye is something that enters the eye from outside of the body. It can be anything from a dust particle to a metal shard.

2.     The foreign object will most likely affect the cornea or the conjunctiva. The cornea is the protective covering of the front of the eye, and the conjunctiva is the mucous membrane that covers the white of the eye.

3.     Go to the emergency room if a foreign object is embedded in your eye. Do not attempt to remove it yourself.

A foreign object in the eye is something that enters the eye from outside the body. It can be anything that does not naturally belong there, from a particle of dust to a metal shard. When a foreign object enters the eye, it will most likely affect the cornea or the conjunctiva.

The cornea is a clear dome that covers the front surface of the eye. It serves as a protective covering for the front of the eye. Light enters the eye through the cornea. It also helps focus light on the retina at the back of the eye.

The conjunctiva is the thin mucous membrane that covers the sclera, or the white of the eye. The conjunctiva runs to the edge of the cornea. It also covers the moist area under the eyelids.

A foreign object that lands on the front part of the eye cannot get lost behind the eyeball, but they can cause scratches on the cornea. These injuries usually are minor. However, some types of foreign objects can cause infection or damage your vision.

Symptoms of a foreign object in the eye

If you have a foreign object in your eye, you probably will experience immediate symptoms. You may experience:

·         a feeling of pressure or discomfort

·         a sensation that something is in your eye

·         eye pain

·         extreme tearing

·         pain when you look at light

·         excessive blinking

·         redness or a bloodshot eye

Cases in which a foreign object penetrates the eye are rare. Typically objects that enter the eye are the result of an intense, high-speed impact like an explosion. Foreign objects that penetrate the eye are called intraocular objects. Additional symptoms of an intraocular object include discharge of fluid or blood from the eye.

Causes of a foreign object in the eye

Many foreign objects enter the conjunctiva of the eye as a result of mishaps that occur during everyday activities. The most common types of foreign objects in the eye are:

·        eyelashes

·         dried mucus

·         sawdust

·         dirt

·         sand

·         cosmetics

·         contact lenses

·         metal particles

·         glass shards

Dirt and sand fragments typically enter the eye because of wind or falling debris. Sharp materials like metal or glass can get into the eye as a result of explosions or accidents with tools such as hammers, drills, or lawnmowers. Foreign objects that enter the eye at a high rate of speed pose the highest risk of injury.

Emergency care

If you have a foreign object in your eye, prompt diagnosis and treatment will help prevent infection and potential loss of vision. This is especially important in extreme or intraocular cases.

Removing a foreign object yourself could cause serious eye damage. Get immediate emergency treatment if the foreign object:

·         has sharp or rough edges

·         is large enough to interfere with closing your eye

·         contains chemicals

·         was propelled into the eye at a high rate of speed

·         is embedded in the eye

·         is causing bleeding in the eye

If you have a foreign object embedded in your eye, or you’re helping someone with this problem, it’s important to get medical help immediately. To avoid further injury to the eye:

·         Restrict eye movement.

·         Bandage the eye using a clean cloth or gauze.

·         If the object is too large to allow for a bandage, cover the eye with a paper cup.

·         Cover the uninjured eye. This will help prevent eye movement in the affected eye.

You should also seek emergency treatment if the following symptoms are present after any type of object is removed:

·         You still have a sensation of having something in your eye.

·         You have abnormal vision, tearing, or blinking.

·         Your cornea has a cloudy spot on it.

·         The overall condition of your eye worsens.

Part 5 of 8: Home care

Home care

If you suspect you have a foreign object in your eye, it’s important to get treatment promptly to avoid infection and the possibility of damaged vision. Take these precautions:

·         Do not rub or put pressure on the eye.

·         Do not use any utensils or implements, such as tweezers or cotton swabs, on the surface of the eye.

·         Do not remove contact lenses unless there is sudden swelling or you have suffered a chemical injury.

If you suspect you have a foreign object in your eye, or you’re helping someone who has one, take the following steps before starting any home care:

·         Wash your hands.

·         Look at the affected eye in an area with bright light.

·         To examine the eye and find the object, look up while pulling the lower lid down. Follow this by looking down while flipping up the inside of the upper lid.

The safest technique for removing a foreign object from your eye will differ according to the type of object you’re trying to remove and where it’s located in the eye.

The most common location for a foreign object is under the upper eyelid. To remove a foreign object in this position:

·         Immerse the side of your face with the affected eye in a flat container of water. While the eye is under water, open and close the eye several times to flush out the object.

·         The same results can be accomplished using an eyecup purchased from a drugstore.

·         If the object is stuck, pull out the upper lid and stretch it over the lower lid to loosen the object.

To treat a foreign object located beneath the lower eyelid:

·         Pull out the lower eyelid or press down on the skin below the eyelid to see underneath it.

·         If the object is visible, try tapping it with a damp cotton swab.

·         For a persistent object, try to flush it out by flowing water on the eyelid as you hold it open.

·         You also can try using an eyecup to flush out the object.

If there are many tiny fragments from a substance, such as grains of sand in the eye, you will have to flush out the particles instead of removing each one individually. To do this:

·         Use a wet cloth to remove any particles from the area surrounding the eye.

·         Immerse the side of your face with the affected eye in a flat container of water. While the eye is under water, open and close the eye several times to flush out the particles.

·         For younger children, pour a glass of warm water into the eye instead of immersing it. Hold the child face up. Keep the eyelid open while you pour water into the eye to flush out the particles. This technique works best if one person pours the water while another holds the child’s eyelids open.

Part 6 of 8: Physician care

Physician care

Contact your physician if the foreign object in your eye has conditions that warrant emergency treatment or if:

·         You did not succeed in removing the foreign object at home.

·         Your vision remains blurred or otherwise abnormal after the removal of the foreign object.

·         Your initial symptoms of tearing, blinking, or swelling persist and do not improve.

·         The condition of your eye worsens despite the removal of the foreign object.

If you get treatment from your physician, you may undergo an examination that includes the following steps:

·         An anesthetic drop will be used to numb the eye’s surface.

·         Fluorescein dye­, which glows under special light, will be applied to the eye via an eye drop. The dye reveals surface objects and abrasions.

·         Your physician will use a magnifier to locate and remove any foreign objects.

·         The objects may be removed with a moist cotton swab or flushed out with water.

·         If the initial techniques are unsuccessful at removing the object, your physician may use needles or other instruments.

·         If the foreign object has caused corneal abrasions, your physician may give you an antibiotic ointment to prevent infection.

·         For larger corneal abrasions, eye drops containing cyclopentolate or homatropine may be administered to keep the pupil dilated. Painful muscle spasms could occur if the pupil constricts before the cornea heals.

·         You will be given acetaminophen to treat pain from larger corneal abrasions.

·         A CT scan or another imaging study may be required for further investigation of an intraocular object.

·         You may be referred to ­a physician who specializes in eye care, known as an ophthalmologist, for further assessment or treatment.

Recovering from a foreign object in the eye

If you succeeded in removing a foreign object from your eye, your eye should begin to look and feel better in about one to two hours. During this time, any significant pain, redness, or tearing should subside. An irritating sensation or minor discomfort may remain for a day or two.

The surface cells of the eye are restored quickly. Corneal abrasions caused by a foreign object usually heal in one to three days and without infection. However, infections are more likely if the foreign object was dirt particles, a twig, or any other object containing soil. Call your doctor if your symptoms aren’t improving.

Intraocular foreign objects can result in endophthalmitis. This is an infection of the inside of the eye. If an intraocular foreign object damages the cornea or lens of the eye, your vision could be damaged or lost.

If you get a foreign object in your eye

·         Wash your hands with soap and water.

·         Try to flush the object out of your eye with a gentle stream of clean, warm water. Use an eyecup or a small, clean drinking glass positioned with its rim resting on the bone at the base of your eye socket.

·         Another way to flush a foreign object from your eye is to get into a shower and aim a gentle stream of lukewarm water on your forehead over the affected eye while holding your eyelid open.

·         If you're wearing contact lenses, it's best to remove the lens before or while you're irrigating the surface of the eye with water. Sometimes a foreign body can be embedded on the undersurface of the lens.

To help someone else

·         Wash your hands with soap and water.

·         Seat the person in a well-lighted area.

·         Gently examine the eye to find the object. Pull the lower lid down and ask the person to look up. Then hold the upper lid while the person looks down.

·         If the object is floating in the tear film on the surface of the eye, try using a medicine dropper filled with clean, warm water to flush it out. Or tilt the head back and irrigate the surface of the eye with clean water from a drinking glass or a gentle stream of tap water.

Caution

·         Don't try to remove an object that's embedded in the eye.

·         Don't rub the eye.

·         Don't try to remove a large object that appears to be embedded in the eye or is sticking out between the lids.

When to seek emergency care

Get immediate medical help if:

·         You can't remove the object with simple irrigation

·         The object is embedded in the eye

·         The person with the object in the eye is experiencing abnormal vision

·         Pain, redness or the sensation of an object in the eye persists after the object is removed

The eye will often flush out tiny objects, like eyelashes and sand, through blinking and tearing. Do not rub the eye if there is something in it. Wash your hands before examining it.

Examine the eye in a well-lighted area. To find the object, look up and down, then from side to side.

·         If you can't find the object, grasp the lower eyelid and gently pull down on it to look inside the lower eyelid. To look inside the upper lid, you can place a cotton-tipped swab on the outside of the upper lid and gently fold the lid over the cotton swab.

·         If the object is on an eyelid, try to gently flush it out with water or eye drops. If that does not work, try touching a second cotton-tipped swab to the object to remove it.

·         If the object is on the white of the eye, try gently rinsing the eye with water or eye drops. Or you can GENTLY touch a cotton swap to the object to try to remove it. If the object is on the colored part of the eye, do NOT attempt to remove it. Your eye may still feel scratchy feeling or uncomfortable after removing an eyelashes or other tiny object. This should go away within a day or two. If you continue to have discomfort or blurred vision, get medical help.

Contact your health care provider and do NOT treat yourself if:

·         You have a lot eye pain or sensitivity to light

·         Your vision is decreased

·         You have red or painful eyes

·         You have flaking, discharge, or a sore on your eye or eyelid

·         You have had trauma to your eye, or you have a bulging eye or a drooping eyelid

·         Your dry eyes do not get better with self-care measures within a few days

Eye Injuries Overview

Eye injuries can range from the very minor, such as getting soap in one's eye, to the catastrophic, resulting in permanent loss of vision or loss of the eye. These types of injuries often occur in the workplace, at home, from other accidents, or while participating in sports.

Eye Injuries Causes

·         Chemical exposures and burns: A chemical burncan occur in a number of ways but is most often the result of a liquid splashing into the eye. Many chemicals, such as soap, sunscreen, and even tear gas, are merely irritants to the eye and do not usually cause permanent damage. However, acids and alkalis are highly caustic and may cause severe and permanent damage to the ocular surface.

o    Acids (such as sulfuric acid found in car batteries) or alkaline substances (such as lye found in drain cleaner and ammonia) can splash into the eyes.

o    Rubbing the eye when working with chemicals may transfer substances from the skin on the hands to the eye.

o    Aerosol exposure is another method of potential chemical injury and includes such substances as Mace, tear gas, pepper spray, or hairspray.

·         Subconjunctival hemorrhage (bleeding): This is a collection of blood lying on the surface of the white of the eye (sclera). The sclera is covered by the conjunctiva, which is the transparent blood vessel containing membrane that lies over the sclera. Subconjunctivalhemorrhage may accompany any eye injury. It may also be spontaneous. The degree of subconjunctival hemorrhage is not necessarily related to the severity of the injury.

·         Corneal abrasions: The cornea is the transparent tissue that is located in front of the pupil and iris. A corneal abrasion is a scratch or a traumatic defect in the surface of the cornea. People with corneal abrasions often report that they were "poked" in the eye by a toy, a metallic object, a toddler's fingernail, or a tree branch or that they wore their contact lens too long.

·         Traumatic iritis: This type of injury can occur in the same way as a corneal abrasion but is more often a result of a blunt blow to the eye, such as from a fist a club or an air bag in a car. The iris is the colored part of the eye. It contains muscles that control the amount of light that enters the eye through the pupil. Iritis simply means that the iris is inflamed.

·         Hyphemas and orbital blowout fractures: These injuries are associated with significant force from a blunt object to the eye and surrounding structures. Examples would be getting hit in the face with a baseball or fist, getting kicked in the face, or being struck in the eye by a racquetball, squash ball, champagne cork, or some similar object.

o    Hyphemas are the result of bleeding in the eye that occurs in the front part of the eye, called the anterior chamber. This is the space between the cornea and the iris. The anterior chamber is normally filled with clear fluid, called the aqueous fluid.

o    Orbital fractures are breaks of the facial bones surrounding the eye. An orbital blowout fracture is a break in the thin bone that forms the floor of the orbit and supports the eye (orbital floor fracture).

o    Lacerations (cuts) to the eyelids or conjunctiva (the clear covering over the white of the eye): These injuries commonly occur from sharp objects but can also occur from a fall.

o    Lacerations to the cornea and the sclera: These injuries are potentially very serious and are frequently associated withtrauma from sharp objects.

o    Foreign bodies in the eye: Generally, a foreign body is a small piece of metal, wood, or plastic.

§  Corneal foreign bodies are embedded in the cornea and, by definition, have not penetrated the eye itself. Iron containing metal foreign bodies in the cornea can cause a rusty stain in the cornea, which also requires treatment.

§  Intraorbital foreign bodies are located in the orbit (or eye socket) but have not penetrated the eye.

§  Intraocular foreign bodies are injuries in which the outer wall of the eye has been penetrated by the object.

§  Ultraviolet keratitis (or corneal flash burn): The most common light-induced trauma to the eye is ultraviolet keratitis, which can be thought of as a sunburn of the cornea. Common sources of damaging ultraviolet (UV) light are welding arcs, tanning booths, and sunlight reflected by snow or water, especially at higher altitudes where UV rays are more intense.

§  Solar retinopathy: Damage to the central part of the retinacan occur by staring at the sun. Common situations that may cause this are viewing solar eclipses or drug-induced states where the person looks at the sun for an extended period of time.

Eye Injury Symptoms and Signs

·         Chemical exposure: The most common symptoms are pain or intense burning. The eye will begin to tear profusely, may become red, and the eyelids may become swollen.

·         Subconjunctival hemorrhage (bleeding): Generally, this condition by itself is painless. Vision is not affected. The eye will have a red spot of blood on the sclera (the white part of the eye). This occurs when there is a rupture of a small blood vessel on the surface of the eye. The area of redness may be fairly large, and its appearance is sometimes alarming. Spontaneous subconjunctival hemorrhages may occur in the absence of any known trauma. If it is unassociated with other signs of trauma, it is not dangerous and generally goes away over a period of four to 10 days with no treatment.

·         Corneal abrasions: Symptoms includepain, a sensation that something is in the eye, tearing, and sensitivity to light.

·         Iritis: Pain and light sensitivity are common. The pain may be described as a deep ache in and around the eye. Sometimes, excessive tearing is seen.

·         Hyphema: Pain and blurred vision are the main symptoms.

·         Orbital blowout fracture: Symptoms include pain, especially with movement of the eyes; double vision that disappears when one eye is covered; and eyelid swelling which may worsen after nose blowing. Swelling around the eye and bruising often occur. A black eye is the result of blood pooling in the eyelids. This can take weeks to disappear totally.

·         Conjunctival lacerations: Symptoms include pain, redness, and a sensation that something is in the eye.

·         Lacerations to the cornea and the sclera: Symptoms include decreased vision and pain.

·         Foreign bodies:

o    Corneal: A sensation that something is in the eye, tearing, blurred vision, and light sensitivity are all common symptoms. Sometimes, the foreign body can be seen on the cornea. If the foreign body is metal, a rust ring or rust stain can occur.

o    Intraorbital: Symptoms, such as decreased vision, pain, and double vision, usually develop hours to days after the injury. Sometimes, no symptoms develop.

o    Intraocular: People may have eye pain and decreased vision, but initially, if the foreign body is small and was introduced into the eye at high velocity, people may have no symptoms.

·         Light-induced injuries:

o    Ultraviolet keratitis: Symptoms include pain, light sensitivity, redness, and a feeling that something is in the eye. Symptoms do not appear immediately after ultraviolet exposure but rather about four hours later.

o    Solar retinopathy: Decreased vision with a small area of central blurring is the primary symptom.

When to Seek Medical Care for an Eye Injury

In most cases, if a person has continuing symptoms of pain, visual disturbance, abnormal appearance of the eye or bleeding, they should go to an emergency medicine physician at an emergency department or see an ophthalmologist (a medical doctor who specializes in eye care and eye surgery) if an ophthalmologist is readily available. A diagnosis and treatment plan can then be reached and should not be delayed due to searching for an on-call or available ophthalmologist; however, discussion with and/or follow-up with an ophthalmologist is often advised.

In general, if a person is not sure if they have a serious eye injury, they should call an ophthalmologist or see an emergency medicine doctor, preferably at a large hospital that has ophthalmologists on call, for advice and/or treatment. In the event of eye injury to children, especially infants or toddlers, an examination should be performed emergently.

An ophthalmologist may be helpful in the following circumstances:

·         Chemical exposures: If people are not sure if the exposure is potentially serious, they have washed out their eye (preferably at an eye-wash station if they are at work), and if they continue to have symptoms, then the ophthalmologist may be able to help them decide whether or not they should be seen immediately.

·         Subconjunctival hemorrhage: If individuals are not sure that they have this condition, an ophthalmologist may be able to help with the diagnosis. This condition, by itself, does not require immediate medical attention.

Continuing pain and decreased vision after an eye injury can be warning signs that require prompt medical attention. If the person has an ophthalmologist, he or she may be able to take care of the patient in their office. Otherwise, go to a hospital's emergency department, preferably in a large hospital where an ophthalmologist is probably on call.

The following conditions should be seen promptly by an ophthalmologist or in the emergency department:

·         Chemical exposures: If the substance was known to be caustic, immediate medical evaluation by either an ophthalmologist or in the emergency department is needed, regardless of symptoms. Acids and alkalis are the worst and require immediate attention. If the substance is not dangerous, such as soap or suntan lotion, a visit to the emergency department is not necessary, but a visit to the ophthalmologist's office may be helpful to alleviate any remaining symptoms. When in doubt, seek medical attention.

·         Lacerations: Cuts that affect the eyelid margins (where the eyelashes are) or the eyeball itself need immediate medical attention.

·         Foreign bodies that are not removed with gentle washing should be evaluated by an ophthalmologist.

·         Solar retinopathy: Evaluation by an ophthalmologist is necessary. This is one condition where there is little that can be done in the emergency department.

·         The foreign body in the eye is sharp or is stuck in the eye or is sticking out of the eyelid.

·         Something hit the eye at a high rate of speed or with force.

·         The person has pain or a change in vision.

1. Remove Foreign Body

Don't try to remove a large object or one that is deeply stuck in the eye. For small particles or something under the upper eyelid:

·         Clean around the eye with a wet washcloth if there are many particles.

·         Rinse the eye with a saline solution or clean water. Or place the affected side of the face in a pan of water; then have the person open and close the eye repeatedly to wash it out.

For something in the corner of the eye or under the lower lid:

·         If the object is under the lid, pull down the skin above the cheek bone.

·         Remove the item with the corner of a damp cloth or moistened cotton swab.

2. See a Health Care Provider

Get medical help if the person:

·         Still feels like there's something in the eye

·         Has abnormal sensation or pain or has changes in vision

·         Continues tearing after you wash out the eye

·         Has a cloudy spot on the cornea

 A foreign object could be a piece of dust, grit, or other substance that comes in contact with the eye. Most of the time, these objects are so small, we don’t notice them – and when they get into the eye, they’re harmless and easily removable. However, depending on the object and how deeply it enters the eye, foreign objects can be serious.

What Causes Foreign Objects?

In the majority of cases, foreign objects are simply particles in the atmosphere that get into the eye because we don’t see them. However, a foreign object can get into the eye for any reason, including accidents, or doing work that creates flying particles without proper eye protection.

Symptoms of Foreign Objects

You will be able to feel a foreign object in your eye. In fact, you probably have if you’ve ever had an eyelash in your eye. If you don’t notice, or have trouble removing the object, your eye may become red or irritated.