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A prospective observational study of techniques to remove corneal foreign body in the emergency department
  1. Michael Quirke1,
  2. Caitriona Mullarkey1,
  3. Shakti Askoorum2,
  4. Norma Coffey3,
  5. James Binchy1
  1. 1Emergency Department, University Hospital, Galway, Ireland
  2. 2Emergency Department, Midland Regional Hospital, Tullamore, Co Offaly, Ireland
  3. 3School of Mathematical Sciences/Systems Biology Ireland, University College, Dublin, Ireland
  1. Correspondence to Mr. James Binchy and Dr Michael Quirke, Emergency Department, University Hospital Galway, Ireland; James.binchy{at}hse.ie, michaelquirke{at}rcsi.ie

Abstract

Introduction Patients  with corneal foreign bodies (CFBs) often present to the emergency department (ED). However, removal techniques vary among emergency physicians (EPs). A prospective, single-blinded, observational study was performed to compare slit-lamp-aided (SLA) versus non-slit-lamp-aided (NSLA) CFB removal by EPs.

Methods Five EPs enrolled consecutive patients with a CFB over 3 months. One blinded EP reviewed patients after 3 days. The study end points were: change in visual acuity; visual analogue pain scale (VAS) score at 12 and 24 h; satisfaction rating; symptoms at follow-up; and rate of complications.

Results 54 patients were enrolled: 28 had SLA removal and 26 NSLA removal; 52 were male; 22 had undergone previous CFB removal; six were wearing eye protection at the time of injury. Forty-three patients were reviewed: 26 by attendance and 18 by telephone. There was no difference in any end points at review. However, patients in the SLA group had median VAS scores that were 1.5 cm lower after 24 h than patients in the NSLA group (p=0.43, 95% CI −2.0 to 1.0). One patient in the SLA group developed keratitis.

Conclusions We show that patient satisfaction ratings, complications and visual acuity were similar for the two methods. There was a trend for increased pain in the NSLA group at 12 and 24 h. Slit-lamp biomicroscopy and the use of magnification to remove CFBs remains the gold standard of care, and more intensive training should be given to EPs at the departmental level, particularly in EDs that receive patients with eye injuries.

  • emergency department
  • ophthalmology

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