Vetnews | September 2024 42 « BACK TO CONTENTS The most severe ocular foreign body injury includes full-thickness penetrating injuries. These are often caused by a large piece of plant material that is sharp, such as thorns or cycad leaves. These eyes are severely inflamed and will present with severe ocular hyperaemia, corneal oedema, uveitis and hyphema. If the lens has been injured a phacoclastic lens-induced uveitis and a cataract will develop. I always recommend referral for these cases as they are best managed by an ophthalmologist. They are not a lost cause, as many of these eyes can be saved but would require microscopic surgery and potentially phacoemulsification surgery to deal with cataract formation. As a general practitioner, the most important thing is to decide if the eye is still visual and to provide supportive care before referral. A few easy methods to use are to evaluate for a menace response, direct and indirect pupil light responses and a dazzle reflex. If any of these are present, then the eye may potentially be saved. An ultrasound examination of the globe may be used to rule out retinal detachment if the ocular media are opaque, such as when the patient has hyphema. The best approach as a general practitioner is to provide support to the globe and relieve inflammation and pain. A thick topical lubricant and broad-spectrum topical antibiotic may be used. A systemic NSAID will help to limit the uveitis and additional pain control may be used if indicated in severely painful cases. An Elizabethan collar should be fitted to prevent self-trauma until the patient is referred. Do not try to remove a full-thickness penetrating foreign body from the globe before referral is offered. The eye will most certainly be leaking aqueous humor (and potentially lens content) and require some form of graft to seal the wound. Thus, it is best done at the referral centre when the graft can be placed immediately after removal of the foreign body. If referral is not an option an enucleation may be performed by the general practitioner. Figure 4: The same cat from Figure 1 during surgery and two weeks after phacoemulsification surgery. The eye made a good recovery and was visual and comfortable. If in doubt please phone your nearest ophthalmologist to discuss any treatment, intervention or referral if presented with an ocular foreign body injury. v Regulars I Ophthalmology Column
RkJQdWJsaXNoZXIy OTc5MDU=