• Suspected foreign body or corneal abrasion.
• History of eye trauma or irritability in a nonverbal patient.
• Abnormal sensation or eye pain, foreign body sensation, photophobia.
• Examination gloves.
• Sterile isotonic irrigation solution (0.9% saline or
lactated Ringer’s). Tap water at room temperature is an
acceptable alternative to prevent treatment delay.
• Topical ophthalmic anesthetic solution (proparacaine 0.5% or
• Cotton-tipped swab.
• Eyelid retractor.
• Suspect an embedded eyelid foreign body when
no object can be visualized and symptoms are persistent.
• If possible, do not apply a topical ophthalmic anesthetic until
a foreign body is visualized or you are confident that none is present.
• Patients can help localize a foreign body but sensation will
be eliminated by the topical anesthetic.
• Patient’s inability to feel increases the potential
for abrasions since there is no further pain or apprehension with blinking,
eye movement, or rubbing.
• A smooth, uncoated metal clip can be bent to into an appropriate
shape to be used as a retractor after sterilization with alcohol.
• Copious irrigation and mechanical removal of a foreign body is
necessary to prevent corneal abrasions, infections, ulcerations,
perforations, and metallic rust rings.
• Eyelid margin: Junction of the internal and external
portions of the eyelid where the eyelashes are located.
• Palpebral fissure: Space between the upper and lower eyelid margins
when the eyelids are open.
• Medial commissure: Medial junction of upper and lower eyelids.
• Lateral commissure: Lateral junction of upper and lower eyelids.
• Lacrimal puncta: Located on the eyelid margin before the medial
• Conjunctiva: Thin transparent membrane.
• Palpebral conjunctiva: Covers the inner surface of the
• Bulbar conjunctiva: Covers the anterior portion of the eye except
for the central cornea.
• Fornix: Transition between the palpebral and bulbar conjunctiva.
• Muscles of the eyelid.
• Ask the patient to direct gaze downward.
• Grasp the eyelashes and distal upper eyelid between the index
finger and thumb and pull downward.
• Place a cotton-tipped swab across the mid-body of the upper eyelid.
• In a single maneuver, move the swab downward and pull the eyelid
upward (Figure 49–2), ...
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