26 Note: Any corneal or limbal foreign body that has penetrated into the anterior chamber must be removed under controlled sterile conditions under magnification (see Chapter 28). Note: Substances such as glass and certain minerals are inert, and rarely cause an inflammatory response. If the foreign body has been present for a few days, is not exposed to the surface (the epithelium has covered the area in a smooth plane), and it has not induced an inflammatory response, it may be left in place, especially if it is near the visual axis, where overzealous removal or burring may cause scarring. Close follow-up is warranted in these cases. If the foreign body is an unknown material, it should be removed. 1. Perform a careful, slit lamp examination, paying particular attention to the depth and nature of the foreign body. 2. If the foreign body is deep, perform Seidel test to rule out penetration into the anterior chamber. 3. If an intraocular foreign body is considered, check angle and lens carefully, measure intraocular pressure, and perform dilated ophthalmoscopy. 4. Diagnostic imaging (B-scan ultrasonography, computerized tomography, and magnetic resonance imaging) may be indicated to rule out an occult foreign body. Ultrasound biomicroscopy may be useful for assessing foreign bodies in the angle.
Corneal Foreign Body Removal
Indications
Superficial foreign bodies that are easily accessible
Stromal foreign bodies such as wood that have a high likelihood of harboring infections
Embedded foreign bodies in the anterior corneal stroma
Any foreign body that has an associated infiltrate
Iron foreign bodies with rust ring formation
Preoperative Procedure
Instrumentation
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