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Wave of Relief for Corneal Foreign Bodies

Clinician's Brief (Capsule)

Ophthalmology

|September 2014

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This retrospective case series of 11 dogs, 2 cats, and 2 horses was the first to describe hydropulsion with sterile isotonic buffered ophthalmic solution (eye wash) for superficial corneal foreign bodies. Superficial corneal foreign bodies may disrupt corneal epithelium but do not penetrate the corneal stroma. Removal includes use of needle, forceps, foreign body drill, or foreign body spud. Hydropulsion is an alternate technique that involves attaching a 25-gauge needle to a 6-mL syringe filled with sterile ophthalmic solution. The needle is broken off and a stream of eyewash is directed at a 45°-angle toward the edge of the foreign body until it dislodges from the corneal surface. Hydropulsion was successful for foreign body removal in all patients in this study. No complications were observed. In all cases, topical antimicrobial treatment was prescribed until 5–10 days’ follow up. In the 9 cases that presented for follow-up, there was no retention of topically applied fluorescein stain. No patients demonstrated signs of ocular discomfort or corneal opacity at final follow up. Hydropulsion is less traumatic than other foreign body removal techniques, which involve touching the cornea with instruments. Hydropulsion, when used properly in appropriate cases (superficial corneal foreign bodies), may result in less corneal fibrosis; however, further studies are necessary.

Commentary

Removal of superficial corneal foreign bodies via hydropulsion provides an efficient, safe, and cost-effective approach that may be used by general practitioners and specialists alike. Of significant benefit, most patients are cooperative enough to allow the procedure to be performed without sedation, utilizing topical anesthetic only. Whereas practitioners should not hesitate to employ sedation, it should be noted that visualization of the foreign body may be compromised by ventronasal globe rotation that occurs with sedation. However, only foreign bodies embedded on the corneal surface are managed by this method, as those penetrating any deeper into the corneal stroma are most appropriately managed by referral to an ophthalmologist for possible surgical intervention.

Alison Clode, DVM, DACVO

Source

Use of hydropulsion for the treatment of superficial corneal foreign bodies: 15 cases (1999-2013). Labelle AL, Psutka K, Collins SP, Hamor RE. JAVMA 244:476-479, 2014.

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