Health Questions and Answers

Question: How can you avoid missing an ocular foreign body?

Answer:

The physician always must have a high index of suspicion for an ocular foreign body, particularly with orbital trauma, sudden eye pain with or without a history of trauma, or visual loss. A hyphema may be the only clue to a penetrating ocular foreign body. The physical examination must include visual acuity testing and meticulous inspection of the eyelids and globe. Careful funduscopic examination should be done but may be difficult in the presence of hemorrhage or cataract formation. External pressure on the globe should be avoided. Small, high-velocity missiles that penetrate the orbital soft tissue or globe may leave no obvious sign of entry. If there is any suspicion, plain films, ultrasonography, or CT scan should be performed. Missed ocular foreign bodies with subsequent loss of visual acuity are a leading source of malpractice losses.

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