
Corneal Foreign Body Removal
Rapid Review
- Background
- Common corneal foreign bodies include metal, glass, plastic, wood, and sand. Must be removed in a timely manner to prevent infection and ocular necrosis
- Indications
- Foreign body in the cornea
- Contraindications
- Intraocular foreign body, hyphema, corneal laceration, multiple foreign bodies
- Complications
- Incomplete removal, conjunctivitis, epithelial injury, corneal perforation.
Pearls
- Use a small needle for removal (30 or 25 gauge needle). You can also try to remove with cotton swab or irrigation to minimize corneal damage.
- After removal, repeat fluorescein exam and look for Seidel defect to ensure that you did not perforate the cornea.

Globe Luxation Reduction
Rapid Review
- Background
- Occurs when the eyelids slip behind the midcoronal plane of the eye in a proptosed eyeball. Orbicularis oculi spasm maintains luxation. Early reduction is required to minimize visual impairment
- Indications
- Spontaneous or traumatic globe luxation
- Contraindications
- No absolute contraindications. Globe rupture is a relative contraindication.
- Complications
- Failure to reduce, retained lashes.
Pearls
- Topical anesthetic drops (tetracaine, proparacaine) can reduce pain and decrease belpharospasm, allowing the provider to reposition the globe more easily.
- When manually reducing, gentle pressure should be applied to the sclera. Avoid putting any pressure on the cornea.

Lateral Canthotomy
Rapid Review
- Background
- Lateral canthotomy is the surgical exposure of the lateral canthal tendon, +/- incision of the inferior branch of the tendon (cantholysis), to relieve intraorbital pressure.
- Indications
- Orbital compartment syndrome (w/ acute loss of vision acuity, proptosis, or IOP > 40)
- Contraindications
- Suspected globe rupture
- Complications
- Globe injury, lacrimal gland/artery injury, incomplete cantholysis, bleeding, infection
Pearls
- All equipment being used during the procedure (needle, hemostats, scalpel) should be directed away from the eye
- If the IOP is still > 40 mmHg after cutting the inferior canthal tendon, you may need to proceed with incision of the superior canthoal tendon.

Slit Lamp Exam
Rapid Review
- Background
- Examination of the eye under magnification to identify pathology within the anterior aspect of the eye and help provide treatment for ocular foreign body removals.
- Indications
- Evaluation of red eye complaints
- Suspected corneal foreign body
- Contraindications
- None
- Complications
- None
Pearls
- To maximize comfort, avoid focusing the beam directly on the patient’s eye when you start.
- If looking at the entire eye at once, use a broad beam. Use the narrow beam when evaluating the anterior chamber specifically. This also helps with patient comfort.

Tonometry
Rapid Review
- Background
- Diagnostic test that measures intraocular pressure.. Early detection of abnormal intraocular pressure can prevent irreversible vision loss
- Indications
- Suspected glaucoma, ocular trauma w/o globe rupture, before/after ophthalmic surgical procedures.
- Contraindications
- Infection, unhealed corneal abrasions/ulcers, ruptured globe
- Complications
- Infection, corneal abrasion, aggravation of ruptured globe.
Pearls
- Tonometry can be very uncomfortable for the patient. Consider applying topical anesthetic (tetracaine, proparacaine, etc.) to the affected eye ahead of time.
- Do not hold the eye during the procedure; this may give a falsely high reading. Try to avoid pulling up/down on the eyelids as well.