Case by David Branson MD, CNH PEM Fellow

A 4  year old previously healthy F presents with concern for ‘eye foreign body.’ The patient reports that a classmate kicked mulch and ‘a splinter flew into her eye.’ A school nurse taped gauze over the eye prior to coming to the ED. 

Patient does not answer questions secondary to anxiety and likely discomfort.  

No history of vision problems.  

No prior surgeries. 

Physical Exam– 

General: Appears uncomfortable , reaching to hold hand over eye frequently
ENMT: Right eye initially covered with white gauze. Gauze removed. 
Right pupil immediately reactive to room light, difficult to assess reactivity to ophthalmoscope light given significant agitation.  No obvious irregularities of pupil, pupil appears round.  Unable to assess extraocular movements and visual acuity secondary to pain and agitation.  dark 1 mm linear foreign body lies horizontally over the sclerae with no notable conjunctival injection, no discharge  

Left eye with extraocular movements intact, reactive to light.  No conjunctival injections or foreign bodies appreciated. 

Ophthalmology consulted and attempted removal in clinic and were unsuccessful due to significant agitation. They request Ketamine Sedation in the ED for FB removal.

Ketamine sedation performed in ED and Ophthalmology attempts removal of foreign body, however again are unsuccessful. They plan for OR removal the following day.

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