Corneal foreign bodies: are antiseptics and antibiotics equally effective?

PURPOSE: To compare the effect of antiseptics and antibiotics on the occurrence of Infectious Keratitis (IK) secondary to Corneal Foreign Body (CFB) removal. METHODS: Multicenter retrospective study conducted between June 2020 and June 2022 in patients referred for CFBs and treated with Picloxydine (Group 1) or Tobramycin (Group 2) for 7 days. A follow-up visit was scheduled on Day 3 (D3) and a phone call on D30. The primary outcome measure was the occurrence of IK. RESULTS: 307 patients (300 men) with a mean age of 42.8 (14.8) years were included. The mean (SD) time to consultation was 43.1 (45.6) hours. Picloxydine and Tobramycin were given to 155 and 152 patients. Half of patients (n = 154, 50.2%) were building workers and 209 (68.1%) did not wear eye protections. CFBs were mainly metallic (n = 292, 95.1%). Upon referral, rust was found in 220 patients (72.1%). A burr was used in 119 (38.9%) patients. IK occurred in 15 (4.9%) patients, 8 (5.3%) in Group 1 and 7 (4.5%) in Group 2 (p = 0.797). IK was successfully treated in all cases. Persistent rust was found in 113 patients (36.9%) on D3 without difference between burr or needle use (p = 0.278). On D3, corneal healing was delayed in 154 patients (47.2%), mainly in burr-treated patients (p = 0.003). The mean (SD) work stoppage duration was 0.32 (0.98) days. CONCLUSION: IK rate was 4.9%. The efficacy of antibiotics and antiseptics was similar on CFB removal. Using a burr was associated with a longer healing time. CFBs had a limited social impact.

Microbiological study on foreign body and vitreous samples of patients with intraocular foreign body.

OBJECTIVE: To evaluate the relationship between the microbiological results of the vitreous humor and those of foreign body specimens in patients with intraocular foreign body (IOFB). METHODS: Seventy-one patients with an IOFB were included in this descriptive prospective case series. All patients underwent immediate IOFB removal. Vitreous sampling was performed during vitrectomy. Foreign bodies were placed directly into culture media for microbiological study. RESULTS: Thirteen (18.3%) patients developed endophthalmitis. The results of microbiological analysis of IOFB and vitreous humor specimens were negative in nine patients and positive in four. Fifty-eight (81.6%) patients with an IOFB had no evidence of endophthalmitis. Among them, seven patients showed positive microbiological results of foreign bodies with no manifestations of endophthalmitis. In five patients, a Staphylococcus epidermidis strain was observed in the culture of the IOFB specimen. Two patients had only positive smear test results of their vitreous humor specimen. CONCLUSION: A correlation appears to be present between the microbiological results of the vitreous humor and IOFB specimens in patients with clinical findings of endophthalmitis but not in patients with a pure IOFB without clinical features of endophthalmitis. This may justify early use of intravitreal and intravenous antibiotics before the development of endophthalmitis.

Adult Eye Conditions: Common Eye Conditions.

In primary care practices and emergency departments, approximately 2% to 3% of visits are related to eye conditions. The most common diagnoses are corneal abrasion, corneal foreign body, conjunctivitis, external hordeolum (stye), and subconjunctival hemorrhage. This section addresses hordeolum, chalazion, conjunctivitis, corneal abrasion, and corneal foreign body. A thorough history and physical examination are crucial for patients with these conditions, and frequently are sufficient for diagnosis. Conservative therapies are first-line treatments for hordeolum and chalazion, including application of warm compresses, eyelid scrubs, and eyelid massage. Conjunctivitis is the most common etiology of red eye and has infectious and noninfectious causes. Bacterial conjunctivitis typically resolves in 1 to 2 weeks, but can be managed with topical antibiotic solutions or ointments. Viral conjunctivitis management involves frequent handwashing and use of cool compresses and artificial tears. Corneal abrasion is the most common eye injury seen in emergency departments, and corneal foreign body is the second most common. Topical antibiotics and cycloplegics are mainstay therapies for corneal abrasion, with consideration of topical nonsteroidal anti-inflammatory drugs for pain management. Follow-up visits are recommended for select patients. Management of corneal foreign body requires prompt removal of the object, pain management, consideration of prophylactic antibiotics, and follow-up when appropriate.

Efficacy of Honey-based Ophthalmic Formulation in Patients with Corneal Ulcer: A Randomized Clinical Trial.

AIM: The aim of this study was to evaluate the efficacy of honey-based ophthalmic drop in patients with foreign body induced corneal ulcer. BACKGROUND: Honey is traditionally used for skin, mucosal and corneal ulcers. Its use is well studied in human skin and mucosal ulcers and animal model of corneal ulcer with promising effects. METHODS: In this randomized clinical trial, 50 patients with foreign body induced corneal ulcer were allocated to receive 70% sterile honey-based ophthalmic formulation or 0.3% ophthalmic ciprofloxacin, as the standard treatment every 6 hours. All the patients were examined for the size of corneal epithelial defect, corneal infiltration and depth and followed on a daily basis until complete healing. Duration for complete healing was considered as the outcome measure. Smear, culture, antibiogram and minimum inhibition concentration (MIC) tests were performed for honey and ciprofloxacin in all patients. RESULTS: The average durations of complete healing of corneal epithelial defect in the honey and ciprofloxacin groups were 3.88 ± 3.44 vs. 6.32 ± 3.69days, respectively (p=0.020). No significant difference was observed between two groups regarding an average duration of healing of corneal infiltration (8.12 ±1.94 days vs. 8.64±2.15 days, p=0.375). MIC of honey for pseudomonas aeruginosa was 60%w/w, for E.Coli 40% w/w, and for staphylococcus aureus 30% w/w. CONCLUSION: Honey based ophthalmic drop can acceleratethe corneal epithelial defect healing in patients with foreign body induced corneal ulcer, compared to ophthalmic ciprofloxacin as a standard treatment. The study was registered in Iranian registry of clinical trial center (IRCT) with registration number IRCT2015020120892N1.

Use of medical sodium hyaluronate gel in surgical removal of a glass intraocular foreign body.

A 38-year-old healthy man presented to our department of ophthalmology after sustaining an ocular injury in a glass explosion more than 10 days prior. A glass intraocular foreign body (IOFB) was found in the left eye. During surgical removal of the IOFB, medical sodium hyaluronate gel was used to detach the IOFB from the retina; this avoided damage to the retina and made it easier for the surgeons to grasp the glass fragment. Multiple surgical instruments have been developed to help remove IOFBs; however, many optic hospitals have limited surgical instruments, thus increasing the difficulty of the operation. The application of sodium hyaluronate gel, a widely used agent, may be a new technique in IOFB surgery.

Effect of gatifloxacin in the treatment of ophthalmological diseases and continuous nursing intervention.

Gatifloxacin is a fourth-generation antibiotic and its antibacterial activity is better. It can play an obvious antiseptic effect in gram-positive bacteria, mycobacterium, mycoplasma, anaerobes and chlamydia. This study analyzed the treatment of the foreign body of the cornea by gatifloxacin eye drops. The results showed that gatifloxacin has a high bacterial clearance rate, which can reach 96.1%. The clinical effect is accurate and the adverse reaction is less. Compared with the control drug levofloxacin, its efficacy and safety were not statistically significant. Moreover, MIC determination of bacteria isolated from the study showed that gatifloxacin had stronger antibacterial activity. At the same time, it can be seen that nursing intervention can effectively improve the satisfaction of the treatment, before the operation, the patient's eye abnormalities, the psychological status of the patient, and the suitability of drug allergy should be evaluated.

Unusual ocular presentations of ocular phaeohyphomycosis.

PurposePhaeohyphomycosis are melanin-containing fungi that rarely infect the eye. We describe three cases of ocular infection with some unusual clinical features.MethodsSeries of three case reports describing three different presentations of phaeohyphomycosis of the eye, their histopathology, and management.ResultsCase 1 mimicked an inflamed conjunctival naevus and was excised on this basis, revealing a conjunctival retention cyst containing pigmented fungal hyphae. Case 2 showed a wooden foreign body incidentally associated with pigmented fungal hyphae, which required treatment with topical antifungal therapy. Case 3 clinically was thought to be a perforated uveal melanoma and comprised an extensive plaque of pigmented fungal hyphae over ulcerated cornea.ConclusionThe pigmented melanin containing hyphae of phaeohyphomycosis mimicked melanocytic lesions in two cases and was an incidental finding in the context of a surface foreign body.

[Orbital cellulitis with concomitant bacteraemia (Stenotrophomonas maltophilia) as a complication of an intraorbital foreign body--a case report and literature review]. / Zapalenie tkanek oczodolu z towarzyszaca mu bakteriemia (Stenotrophomonas maltophilia) jako powiklanie wewnatrzoczodolowego ciala obcego--opis przypadku i przeglad pismiennictwa.

This is a case report of a 53-year-old man, who presented in the Department of Ophthalmology with signs of orbital cellulitis on the right side, which developed over a few days following an injury. Computed tomography revealed inflammatory infiltration of the orbital soft tissues, penetrating to the sella turcica. Orbital swab and blood cultures revealed the presence of Enterobacter and Peptostreptococcus spp. as well as Stenotrophomonas maltophilia, respectively. Review of the literature relevant to the presented case was performed based on the PubMed databasesearch, using the following keywords: intraorbital foreign body, orbital cellulitis, neuroinfection, Stenotrophomonas maltophiia.. Summarizing, the orbital injury-associated infections can be potentially life-threatening, due to the proximity of the anterior cranial fossa. Hence, they require prompt diagnosis and intensive treatment.

Corneal inflammation from pine processionary caterpillar hairs.

PURPOSE: Hairs from the caterpillar of the pine processionary moth, Thaumetopoea pityocampa, located in the pine forests of southern Europe and elsewhere, can become embedded in the cornea and conjunctiva. Disorders produced by the urticating hairs can be classified into a broad spectrum of severity from mild keratoconjunctivitis to anaphylactic shock. This report presents 3 cases that illustrate the range of corneal responses to embedded hairs of the processionary moth caterpillar. METHODS: Case series and review of the literature. RESULTS: A 51-year-old man (case 1), a 46-year-old woman (case 2), and a 67-year-old man (case 3) presented different manifestations as a result of contact with pine processionary caterpillar hairs. Case 1 had acute keratitis with decreased vision. He was treated with a corneal depot steroid 4 times daily for 3 months. After 4 months, he was asymptomatic. Case 2 had acute keratitis without vision symptoms. She was released without treatment, and 1 month later was asymptomatic. Case 3 experienced dry gritty sensations, probably because of blepharitis, but also presented asymptomatic caterpillar hairs embedded in the corneal stroma. He was instructed regarding lid hygiene for his blepharitis, and after 3 months the embedded caterpillar hairs had disappeared. CONCLUSIONS: The most common ocular presentation of embedded hairs from the pine processionary moth caterpillar is keratitis. The urticating hairs can cause corneal infiltrates that disappear progressively over time. Steroid eye drops accelerate the resorption of these infiltrates.

Post-traumatic Infectious Endophthalmitis.

Post-traumatic endophthalmitis is an uncommon yet devastating complication of an open globe injury. Risk factors include presence of an intraocular foreign body (IOFB), lens rupture, delayed primary globe repair, rural trauma, and trauma with contaminated objects. Visual prognosis in post-traumatic endophthalmitis is affected by the virulence of the microbe, the presence of a retinal break or detachment, the timing of treatment, the presence or absence of an IOFB, and the extent of initial injury. Treatment should be started emergently with systemic and intravitreal antibiotics. In the setting of penetrating ocular trauma, antibiotic prophylaxis of endophthalmitis should be considered. The best treatment regimen has not been determined. The most frequent prophylactic regimens are: treatment with oral antibiotics, a short course of intravenous antibiotics followed by oral antibiotics, or intravitreal antibiotics plus oral antibiotics.

Trochlear calcification mimicking an orbital foreign body.

A 39-year-old man presented with diplopia 1 day following left orbit trauma. CT scan and ultrasound showed a left trochlear hyperintensity that was interpreted by both the radiologist and echographer as a metallic foreign body. Surgical exploration failed to identify a foreign body. The patient presumably had preexisting trochlear calcification with a post-traumatic nonconcomitant small-angle vertical deviation and diplopia. Calcification should be considered in the differential diagnosis of trochlear hyperintensity noted on imaging studies.

Bee sting of the cornea and conjunctiva: management and outcomes.

PURPOSE: To present the clinical features, management, and outcomes of 4 cases of bee sting injury to the cornea and conjunctiva. METHODS: Clinical features, external photographs, treatment, and outcomes of 4 cases of ocular bee stings are presented. RESULTS: In 3 cases, the stinger of the bee was retained on the cornea, and in 1 case, it was retained on the conjunctiva. One of the 3 corneal sting patients was stung on the laser in situ keratomileusis flap margin, which resulted in a partial tear of the flap. Retained bee stings were removed immediately in all 4 cases, and topical antibiotics were applied with adjuvant treatment. All patients had good visual outcomes without severe complications at follow-up. CONCLUSIONS: Ocular surface bee stings with retained stingers are rarely reported. A potential triad of penetrating, immunologic, and toxic injury must be taken into consideration. Vision can be restored by early removal of the sting and topical medication.