A 20 year old male presents after grinding some metal three days ago without any eye protection. He now has pain in his left eye. This is what you see on examination:
What should you do next?
1 – attempt removal
2 – CT scan
3 – antibiotics and discharge with close follow up with ophthalmologist
4 – all of the above
If someone has foreign body from grinding metal you should always be concerned about the possibility of an intraocular foreign body. CT without contrast should be ordered. Don’t confuse this with any other kind of foreign body in the eye. Grinding metal in particular can cause deeper penetrating injuries because things can enter the eye at high speed.
Of course always fluoroscein these peeps to make sure there’s no globe rupture. Either way they should given antibiotics to prevent infection.
So the answer to this question was actually #4: you would attempt removal, order a CT scan, give antibiotics, and discharge with close outpatient followup.
Bonus points if you know the name of the the sign that indicates globe rupture:
Seidel’s sign
