TRAUMATIC CONDITIONS OF THE EYEOphthalmic Emergencies 4134 Take care to irrigate all corners of the eye and to evert the upper eyelids to
remove any particulate matter, and to irrigate the superior fornix of the
conjunctiva.
5 Refer the patient immediately to the ophthalmology team, unless f luorescein
staining reveals no corneal damage and the surrounding conjunctiva
appears norma l and is pain-free, i.e. no injur y is apparent.
Conjunctival foreign body
DIAGNOSIS AND MANAGEMENT
1 Usually a piece of grit blows into the eye causing pain, redness and watering,
and is easily seen on direct v ision.
2 Remove with a moistened cotton-wool bud after instilling local anaesthetic.
Provide an eye pad to be worn for 1–2 h until the return of normal sensation.
3 The object may have impacted on the upper subtarsal conjunctiva if nothing
is seen immediately. The eye will be red and painful to blink, and f luorescein
staining will revea l multiple linear cornea l abrasions.
4 Evert the upper eyelid.
(i) Stand behind the patient to evert the upper lid, supporting the
head against your body.
(ii) Instruct the patient to look downwards, pull the upper lid
eyelashes down and then up and over the tarsal plate, which is
held depressed by a glass rod or orange stick (see Fig. 14.1).
(iii) Remove the foreign body with a moistened cotton-wool bud.5 Give the patient antibiotic drops for 2 days if f luorescein shows signs of
corneal abrasion.
Figure 14.1 Eversion of the upper eyelid
(a) Lifting the tarsal plate up and over, and (b) demonstrating the underside of the upper
eyelid (subtarsal conjunctiva).
(a) (b)