CONJUNGTIVAL

FOREIGN
BODIES
CAUSES

Work related particles (drilling,

Sanding)
Environmental (Sand, Dirt)
SYMPTOMS

History of trauma
Tearing
Symptoms Foreign body sensation
"Trash in my eye"
Foreign body feels as if it is moving
Object usually lodged under upper lid
and not mobile
As patient blinks, different Cornea
parts irritated
CRITICAL SIGN
Conjungtival foreign body
OTHER SIGN :
- Conjungtival Injection
- Eyelid edema
- Linear, vertical corneal abrasions
may indicate a foreign body
under the upper eyelid
FOREIGN BODY IN UPPER EYELID
CONJUNCTIVA
Foreign body
penetrating the
conjunctiva
(subconjunctival
)
WORK UP
1. History :- Determine the
mechanism of injury.
- What kind of the foreign body
2. Document visual acuity before
any prosedure is performend. (one
or two drops of topical anesthesia
may be necessary to control
blepharospasm and pain
3. Slit-lamp examination :
- Locate and assess the depth of the
foreign body.
- Evert the eyelid and inspect the fornices
for additional foreign bodies for additional
foreign bodies.
- Double everting the upper eyelid with a
desmarres lid retractor may necessary.
- Topical fluorescein should be instilled to
help localized foreign body and to check
for the secondary corneal abrasions.
Evert the eyelid
Double eversion of the upper lid. To visualize
the fornix, the everted upper lid must be
further lifted away from the globe. Here a
Desmarres lid speculum is inserted behind
the tarsal plate to allow inspection of the
Subtarsal
foreign body
after simple lid
eversion

no surface corneal foreign body usually seen patient often

accurately describes something under the lid and pain with
blinking linear abrasions seen with fluorescein in the upper
cornea are typical
Removal of foreign bodies
from the upper lids conjunctival
surface is a great relief for the
patient as these objects scratch the
cornea (twice) with each blinking.
How to make the eyelid
retractor from a paper clip
Some small nonreactive
particulate objects can be
left in place without
complications, while
certain deeply embedded
foreign bodies (e.g., small
metallic or glass
fragments) will work
DIFFERENTIAL DIAGNOSE
Corneal foreign body
- Superficial punctate keratitis
- A small infiltrate may surround a
corneal foreign body (sterile infiltrate)
- An orange-brown rust ring results in
iron foreign body
Corneal abrasion
- No foreign body
-Caused by contact with a finger,
fingernail, or even the edge of piece of
paper
Conjungtival hemorrhage
- without history of antecedent trauma
- occasionaly a history of vomiting,
coughing, or other forms of valsalva
maneuver.
- If recurrent, can be seen in
association with systemic illness such
as uncontrolled hypertension, diabetes
mellitus, or a bleeding diathesis.
Acute conjunctivitis
- Conjunctival hyperemia, discharge,
eyelid sticking (worse in morning),
foreign body sensation,
- No history of trauma
TREATMENT
1. Remove foreign body under topical
anesthesia
- Multiple foreign bodies can often be
removed with saline irrigation
- Foreign matter embedded in tissue is
removed with a sterile, disposable needle.
- A foreign body can be removed with a
cotton-tipped applicator soaked in topical
anesthesic. Or fine forceps.
- For deeply foreign body, consider
pretreatment with a cotton-tipped
applicator soaked in phenylephrine,2.5%,
to reduce conjungtival bleeding.
 - Small, relatively inaccessible, buried
subconjunctival foreign bodies may
sometimes be left in the eye without
harm. Occasionally they will surface with
time, at which point theymay be
removed more easily.
2. Sweep the conjungtival fornices with a
glass rod or cotton-tipped applicator
soaked with a topical anesthetic to catch
any remaining pieces.
3. If any large laceration (>1 to 1.5 cm)
may be sutured, but most laceration
heal without surgical repair.
3. A topical antibiotic may be used
4. Artificial tears may be given for
mildly irritated eye.
FOLLOW-UP
Follow up as needed, or in 1 week if
residual foreign bodies were left in
the cunjunctiva.

INDICATION TO REFER TO
OPHTHALMOLOGY :
Persistent symptoms (esp. glass
fragment exposure)
Difficult removal of foreign body
Deep Laceration associated with
foreign body
SUBCONJUNCTIVAL
HEMORRHAGE
Zones for closed globe injury. Zone I,
injury
involves only conjuntivae, sclera, or
cornea. Zone II, injury
to structures in the anterior chamber
including the lens and
zonules. Zone III, injury to posterior
structures including
the vitreous, retina, optic nerve,
choroid, and ciliary body.
Subconjunctival hemorrhage
(SCH)

Symptoms
Sudden onset of painless red eye.
Occasionally patient says he felt
something give or pop.
Signs
Localized dense red haemmorhage on an
otherwise normal eye.
It appears as a bright red patch of
conjunctival tissue with distinct or borders.
If it is severe, the conjunctiva may become
elevated and prolapse through the palpebral
fissure; the entire bulbar conjunctiva may
Localized dense red
haemorrhage
Subconjunctival
hemorrhage

but is most commonly

idiopathic,
Subconjunctival
hemorrhage
KEY POINTS
A subconjunctival
haemorrhage is usually
idiopathic
as a result of even minor ocular
trauma;
spontaneously
hypertension or
blood dyscrasia,
Common causes of red eye are
conjunctivitis, keratitis, uveitis and
acute angle-closure glaucoma.
Extensive subconjunctival hemorrhage
due to trauma.
The examiner needs to consider the
possibility of globe rupture or
Acute massive orbital haemorrhage with
proptosis
NB May need urgent lateral
cantholysis and canthotomy to drain a
traumatic retrobulbar haemorrhage
Treatment
Reassure it will resolve
spontaneously.
Ask patient about excessive
straining such as severe
coughing or vomiting which can
cause SCHusually bilateral.
It musbe ensured that the
hemorrhage does not indicate or
conceal a deeper or more
extensive injury
Subconjunctival Hemorrhage
Generally resolving spontaneously
in 7 to 10 days, its color evolves from
bright red to yellow green.
Occasionally, when the hemorrhage
involves the perilimbal conjunctiva,
blood breakdown products can be
seen in the anterior peripheral
corneal stroma as a greenish
discoloration.
PITFALL
The presence of subconjunctival
pigmentation
in association with a hemorrhage
is very
suspicious of occult scleral
rupture.
The examiner must obtain a
complete ocular history and
perform an examination on all
patients presenting with
traumatic subconjunctival
 PROGNOSIS AND OUTCOME
The prognosis for the vast majority of
conjunctival injuries is excellent.

The conjunctiva heals rapidly and, due to its

rich blood supply, infections are rare.

In addition, destruction of the specialized

cellular components of the conjunctival surface
may permanently change the composition of the
preocular tear film with unfortunate sequelae for
the corneal surface.
SUMMARY
The conjunctiva is a frequently
injured ocular structure.
If the injury is isolated to the
conjunctiva the prognosis is often
excellent and rarely requires
surgical intervention.
The most important aspect of
conjunctival
injury is that it may signal the
A complete evaluation
of the eye and adnexa
must be performed to
ensure that the full
extent of the injury is
recognized and
appropriate testing and
treatment are
undertaken.
THE NONOPHTHALMOLOGISTS
ROLE
Most of the minor conjunctival
injuries can be managed by

nonophthalmologist.

Foreign BodySubconjunctival hemorrhag