Definition Sometimes small objects get under the eyelid but do not penetrate the eyeball itself. These can cause irritation and discomfort in the eye and must be removed.
What are the signs and symptoms of the injury? Symptoms include:
sensation of something in the eye
possible itching
redness
tearing
swelling of eyelids
pain
What are the causes and risks of the injury? Several things can lead to material entering the eye and being trapped under the lid. Airborne debris can fly into the eye. This might occur in a strong wind. It is also a risk when working around sawdust or grinding metal. It may also occur while doing yard work or working under a car. Other eye problems such as scratches on the cornea, called corneal abrasions, can create the sensation of something in the eye. Irritation from an infection with the herpes simplex virus can also cause this feeling. When a person has the sensation of an object in the eye, this possibility must be ruled out before other conditions are considered.
What can be done to prevent the injury? Safety glasses are an important means of prevention when there is foreign matter in the air. They should be worn in all situations where matter might enter the eye. These include:
grinding
working with sheet metal
working under a car
mowing the lawn
welding
How is the injury recognised? The doctor diagnoses the condition by looking for the object under the eyelid or on the surface of the eye. Very small objects, such as a clear piece of thistle, often cannot be seen without a microscope.
What are the treatments for the injury? The goal of treatment is to remove the object from the eye. This can be done in a variety of ways. One method is to place a cotton-tipped swab against the upper lid with the eyelids closed. Next, the eyelid is flipped over the swab by grasping the upper eyelashes. This allows the mucous membrane lining of the lid to be checked for foreign matter. If foreign material is found, it can be removed with another swab. This technique usually does not require medication to numb the eyelid surface. However, if the foreign body is found on the cornea, numbing medication may be needed before the object can be removed.
Metallic objects sometimes stick to the eye's surface and cannot be loosened by blinking. In this case, the object has to be removed manually. A microscope is often used to aid the process. Metallic bodies left on the eye longer than 12 to 24 hours may oxidize. This produces a rusty tattoo-like ring. This rusty material needs to be removed as well. A doctor must perform this procedure. Eye drops are used to numb the area. Sawdust or other pieces of plant matter can usually be removed in one piece without further cleaning.
Another technique for removing objects from the eye is to flood the eye with water. A magnifying glass can help see the object more clearly. Doctors also use magnifiers when retrieving objects from the eye. This is especially helpful in removing the small glass fragments that get under the eyelids during car accidents.
Sometimes foreign bodies are so small that it takes a day or two before the person feels discomfort. The eye will usually appear red and irritated. This often happens with young children. In injuries from explosions, several foreign bodies may be found on or even under the surface of the eye. As many of these as possible should be removed. Others may work their way to the surface over a period of weeks or months. The eye is able to continue functioning even when foreign objects are present. The material should be removed when it begins causing discomfort.
After foreign matter is removed from the eye, an antibiotic eye drop, such as chloromycetin or ciprofloxacin, may be used for several days to prevent infection. If there is a scratch on the eye, a pressure patch may be placed over the eye for a day or two.
What are the side effects of the treatments? Generally speaking there are no side effects of treatment. All medications are associated with side effects including irritation. Patients should tell their doctor about any irritation to the eye.
What happens after treatment for the injury? After treatment most patients return to their normal activities. Some times sunglasses are worn to avoid irritation from sun or wind.
Most individuals require routine ophthalmic examinations to make sure the eye is healing properly. Corneal lesions must be watched for scarring.
Author: William Stevens, MD Reviewer: eknowhow Medical Review Panel Editor: Dr John Hearne Last Updated: 6/1/2005 Contributors Potential conflict of interest information for reviewers available on request
