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Ophtho Case Review: Corneal Foreign Body

emergency & critical care freaky fr-eye-day ophthalmology

Its time to celebrate all of the freaky eye stuff!  Tell me you have something better to do on this fantastic Friday night?   

This dog has been squinting since Wednesday.  He comes in to see you on Friday afternoon at 4:55pm and this is what you see! 


That is a corneal foreign body.


How do you think you should proceed?

  1. NUMB THE EYE:

    Topical proparacaine is your friend here. Numb this eye and then you need to either flush the eye with saline or get some tiny forceps to get up under that and remove it. I use tiny forceps called Colibri's but any small blunt tipped forceps will work!
    *Most corneal foreign bodies will adhere to the cornea surface with some pretty serious surface tension, like a popcorn kernel to your gums, so flushing does not always work.

  2. TREAT THE ULCER


This is a deep one!  The dark spot in the center is actually a descemetocele in this case and I would recommend a conjunctival pedicle graft for this one, however, many just have either a superficial ulcer or a mid-stromal ulcer underneath.  You'll need to assume this is infected, since plant material was embedded. Treat with a fluroquinolone, like ofloxacin, every 4-6 hours until recheck and use an e-collar and prescribe some form of oral pain medication.  

*In most of these cases, the comfort improves SIGNIFICANTLY as soon as the foreign body is removed!

*Many of these will have a stromal defect due to collagenolysis caused by the presence of the foreign body so it is not wrong to use autologous serum in these cases!

#coolcases


 

About the Guide: Kristin Miller Fischer, DVM, DACVO
 

Dr. Kristin Fischer is a board-certified veterinary ophthalmologist. She graduated from the University of Tennessee College of Veterinary Medicine in 2007 and completed a rotating general internship at VCA Alameda East Veterinary Hospital in Denver, CO. She then returned to Knoxville in 2009 to complete her ophthalmology residency at UTCVM. Dr. Fischer practices in South Carolina and works at Animal Eye Care of the Lowcountry. She loves the challenge of the complicated cases and the frequent connection between ophthalmology, internal medicine and neurology. Her favorite thing is returning sight to blind animals and then seeing them greet their families post-op!

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