Perforating eye injuries from foreign body are uncommon. More commonly the foreign bodies are found in the subtarsal area and cornea where there can be easily removed.

Presentation:

• pain 
• red eye and
• watery eye 

• visual acuity is important, in the presence of severe pain and blepharospasm visual acuity is checked after instillation of topical anesthesia. Intraocular foreign body can cause drop in visual acuity through cataract or vitreous haemorrhage
• note any distortion of the pupil or iris which may be caused by a perforating injury
• eversion of the upper lid is essential as foreign body may be lodged in the subtarsal area causing corneal abrasion

• subtarsal or corneal foreign bodies can easily be removed with a cotton bud following instillation of topical anesthesia.
• refer patient within 24 hours if the corneal foreign body cannot be easily or completely removed.
• any patient with suspected intraocular foreign body should be referred immediately. History suggestive of intraocular foreign body include the use of hand-hammer on metal or accidnts with industrial power tool

Figure 1. Metal corneal foreign body. This can be easily removed with a cotton bud after  application of topical anesthesia.

Figure 2 A painful eye caused by a subtarsal foreign body. Eversion of the upper lid reveals the  foreign body which may otherwise be missed.

Figure 3 This welder sustained a penetrating injury at work. The picture shows a piece  of iron foreign body embedded in the vitreous. This was removed within 24  hours by the vitreoretinal surgeon. Intraocular iron is toxic to the eye tissue and should be removed.

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