This accounts for a more sterile procedure by keeping the eyelashes as far as possible, and reduces the chance of eliciting a blink reflex. If necessary, the eyelids can be kept open using an eyelid speculum, the examiners fingertips, a cotton tip or an assistant. Anaesthetic and pupil dilator: Local anaesthetic is instilled into both eyes in order to reduce blepharospasm. Topical oxybuprocaine 0.4% is the preferred choice as it has an onset of action of 20 seconds and a half-life of 20 minutes. A drop of topical pupil dilator such a cyclopentolate 1%, if available, can be helpful to reduce ciliary spasm after removal of the foreign body. Atropine is generally avoided due to its long-lasting mydriatic effects. Removal techniques: There are mainly two types of techniques, the choice of which will depend on the nature of the foreign body. The first technique is the cotton tip removal, which is indicated in superficial foreign bodies with no surrounding corneal reaction, and the second is the hypodermic needle or nº15 blade removal with which the complete foreign body and any surrounding rust ring can be removed. Irrigation of the ocular surface and upper and lower fornices can be performed after the procedure to wash out any residual loose foreign body material. A 10 mL ampoule of sterile saline is usually sufficient. Medications
Current recommendations stress the need to use topical and/or oral analgesia and topical antibiotics.
One review has found that eye drops to numb the surface of the eye such as tetracaine improve pain; however, their safety is unclear. Another review did not find evidence of benefit and concluded there was not enough data on safety. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) are useful to reduce the pain caused by corneal abrasions. Diclofenac and ketorolac are the most used, one drop four times a day. It is worth noting, however, that diclofenac may delay wound healing and ketorolac should be avoided in people who wear contact lenses. Some studies do not recommend using topical NSAIDs due to the risk of corneal toxicity. There is no direct evidence regarding the use of oral analgesics, but because pain relief is the main concern for people with corneal abrasions, these are prescribed according to individuals characteristics. Topical antibiotics are used to prevent concomitant infections, which result in slower healing of corneal abrasions. Ointments are considered the first-line treatment, as they are more lubricating than drops. If the person uses contact lenses, an antibiotic with anti-pseudomonal activity is preferred (ciprofloxacin, gentamicin or ofloxacin), and the use of contact lenses should be discontinued until the abrasion has healed and the antibiotic treatment has ended. This is because contact lens wearers are often colonized with Pseudomonas aeruginosa, which may cause corneal perforations and subsequent permanent vision loss.