T15.11XA-12XS Foreign Body In Conjunctival Sac

Conjunctival foreign bodies may be classified by material and the most common include the following:

• Metal
• Plastic
• Glass
• Organic material

Structural Damage to the Eye

• Inflammatory cascade begins with damage to the conjunctival epithelium
• Inflamamtory mediators produce dilation of conjunctival blood vessels
• Mechanical trauma produces edema of the eyelids
• Conjunctival edema develops

Functional Damage to the Eye

• None

The main goal of the diagnostic evaluation in a patient with conjunctival foreign body is to accomplish the following:

• Ensure that a foreign body is the cause of the chief complaint
• Relieve ocular pain and discomfort
• Perform a preoperative assessment before removing the foreign body

Patient History

Patients with conjunctival foreign body may present with the following signs and symptoms:

• Blepharospasm
• Excessive watering of the eye
• Photophobia
• Conjunctival injection
• Mild foreign body sensation to severe pain
• Inability to localize the source of the foreign body sensation

Clinical Appearance of the Cornea

• Look for epithelial damage
• Evaluate with fluorescein dye

Corneal abrasion secondary to embedded conjunctival foreign body Corneal defect enhanced with fluorescein dye Superotemporal epithelial defect suggests a retained foreign body under the upper eyelid

Clinical Appearance of the Conjunctiva

• Look for hyperemia
• Evaluate with fluorescein dye

There is no standard classification system for conjunctival foreign bodies.  In a general sense, they can be classified by the type of material (e.g., glass, plastic, metal, wood, etc.) and/or by the depth of the object:

• Superficial foreign body
• Embedded foreign body

Patients with conjunctival abrasions and patients with conjunctival foreign bodies share a common history in that both groups have a history of recent ocular trauma.

The primary goals of treating a patient with a conjunctival foreign body includes the following:

• Determine the number of foreign bodies (single or multiple)
• Identify the location (superior palpebral conjunctiva, bulbar conjunctiva, or inferior palpebral conjunctiva)
• Assess the degree of embeddedness of the foreign body
• Removal of foreign body

The use of topical ophthalmic anesthetic solution is avoided unless the patient is very uncomfortable and exhibits significant blepharospasm, or if the foreign body is substantially embedded.  Topical anesthesia is avoided so that when the particle is located and removed, the patient will feel immediate relief, indicative that no foreign bodies remain in the eye.  

On occasion the foreign body may irritate the cornea sufficiently so that, even following removal, the eye is still sensitive and uncomfortable.  A thorough slit lamp examination with lid eversion will confirm that no other foreign bodies remain in the eye.  If necessary, topical ophthalmic anesthetic solution is used to maximize patient comfort during the procedure.

1.  Dahl A.  Conjunctival Foreign Body Removal.  Medscape. 8 Aug 2013. http://emedicine.medscape.com/article/1844102-overview.  Last accessed August 8, 2014.