Ocular foreign body sensation

Specialty: Ophthalmology.

• grit in the eye
• sensation of eye rubbing
• corneal foreign body

Why it occurs

• Moderate or severe keratoconjunctivitis sicca
• Presence of a retained conjunctival or corneal foreign body (e.g., metal splinters, wood, sand)
• Trichiasis or distichiasis (aberrant eyelashes that mechanically contact the cornea)
• Superficial corneal erosion, abrasion or ulcer
• Superficial punctate keratitis secondary to ultraviolet exposure (actinic ophthalmia) or drug toxicity
• Corneal filaments (filamentous keratitis)

Initial workup

Systematic biomicroscopy with a slit lamp, performing eversion of the upper and lower eyelid to look for foreign bodies impacted in the fornix or tarsal conjunctiva; Staining with 1% sodium fluorescein eye drops visualized with cobalt blue light filter to identify corneal abrasions or ulcers; Seidel test; X-ray or CT of the orbit (never MRI if there is suspicion of a metallic intraocular foreign body).

Standard management

• Tobramycin — 0.3% eye drops, 1 drop every 6 hours for 5 days as prophylactic antibacterial coverage after removal of a non-infected foreign body
• Sodium hyaluronate — 0.15% or 0.4% eye drops without preservatives, 1 drop every 1-2 hours to promote corneal re-epithelialization and lubrication
• Ciclopentolate (1% eye drops, 1 drop every 8 hours to induce cycloplegia and relieve pain due to ciliary muscle spasm if there is significant central corneal abrasion).