New York State Medical Treatment Guidelines for Foreign Bodies, Rust Rings and Corneal Abrasions in workers compensation patients

The guidelines provided by the New York State Workers Compensation Board offer general principles for managing Foreign Bodies, Rust Rings, and Corneal Abrasions. These directives aim to assist healthcare professionals in determining appropriate strategies for diagnosing and addressing issues related to the presence of foreign bodies, rust rings, and abrasions on the cornea as part of a comprehensive care plan.

Healthcare practitioners specializing in the management of Foreign Bodies, Rust Rings, and Corneal Abrasions can rely on the guidance from the Workers Compensation Board to make well-informed decisions about the most suitable approaches for assessing and treating these specific eye conditions in their patients.

It is crucial to emphasize that these guidelines are not intended to replace clinical judgment or professional expertise. The ultimate decision regarding the management of foreign bodies, rust rings, and corneal abrasions should involve collaboration between the patient and their healthcare provider.

Occupational Eye Issues: Beyond the Numbers

When it comes to eye troubles on the job, foreign objects and corneal abrasions take the lead. Usually, pros can handle them without much fuss, but there’s a twist – complications like infections can show up now and then.

Diverse Dangers: Know Your Risks

The risks aren’t one-size-fits-all across jobs. Whether it’s foreign bodies or corneal abrasions, these eye issues can pop up in almost any job. However, the ones most in the line of fire are the folks in construction and metalworking gigs, especially where heavy-duty impacts or grinding are part of the daily grind.

In the Line of Fire: Who’s Most Vulnerable

Work-related injuries are a common tale, with grinders, welders, those in dusty environments, and the drill-happy crew taking the lead. If you’re facing the wind on the job, you’re in the zone of vulnerability too. Now, eye protection does help, but it’s not the superhero cape – risks are cut, but they don’t vanish.

Figuring Out the Cause

Finding the cause isn’t a detective story here. Symptoms hit fast, so causation isn’t a head-scratcher.

By the Numbers: Who’s Getting Hit

No stats cover the whole population, but here’s a glimpse – guys between 20 and 40 are more likely to land in the eye trouble zone compared to the ladies. And while corneal abrasions are on the radar in surgery rooms and intensive care, we’re steering clear of that track in this guide.


Signs and Symptoms

When it comes to corneal abrasions, foreign objects, or those pesky rust rings, the symptoms are your compass:

  • Feeling Something’s Off: That classic foreign body sensation.
  • Quick Entrance: Symptoms come on the scene suddenly, usually tied to a specific event like a metalworking mishap.
  • Pain Check: Expect some discomfort, especially if the foreign object is on the larger side or if there’s a hefty abrasion.
  • Tear Alert: Your eyes might well up – tearing is part of the package.
  • Seeing Red: Redness is a common companion.
  • Sunlight Struggles: If things are more serious, bright lights might not be your friend – that’s photophobia.
  • Sight Stayin’ Strong: Generally, your vision stays intact unless the visual axis takes a hit.

Time of Onset: It’s a Flash

When these symptoms crash the party, they do it suddenly. Think metalwork accidents or moments when you’ve been going at your eye, maybe with or without that initial foreign body feeling.

Current Fixes: Less is More

Typically, there’s no grand treatment plan in play. At most, you might have washed out your eye. It’s often a waiting game.

Past Experiences: The Job’s Shadow

If you’re dealing with corneal foreign bodies now, chances are this isn’t your first rodeo. Those in metalworking or similar gigs are often repeat players in the eye risk arena.

Keeping an eye out for red flags is crucial, especially when it comes to potentially severe injuries. Here’s what to watch for:

  • Metalworking Mayhem: If there’s a history of hardcore metalworking minus the eye protection, that’s a red flag waving.
  • Deep Impact: When there’s suspicion of something piercing through the eye globe, that’s a major concern.
  • Torn Cornea: A cut or tear on the cornea is another red flag.
  • Globe Trouble: Things get serious with a lacerated or ruptured eye globe or if something’s impaled in there.
  • Eye Movement Hiccups: If your eye can’t move as freely as it should, that’s a cause for concern.
  • Slow-Burn Sensitivity: If light sensitivity creeps in gradually without any clear triggering event, that’s a red flag.
  • Beyond the Eye: When there are overall systemic symptoms, especially linked to rheumatological issues, that’s concerning.
  • Pus Problem: If there’s pus in the mix, it’s a clear signal of trouble.
  • Vision Woes: When your vision takes an unexplained hit, and there’s no foreign object or abrasion causing it, that’s a red flag too.



Getting the Full Picture

Begin by checking the visual acuity for all patients, especially if the injury involves the visual axis or is extensive. A detailed history of the event’s duration and any previous eye issues is crucial. Dig into the patient’s eye history, exploring past traumas and diseases, and also inquire about any systemic diseases. Record any prior treatments.

Move on to a thorough eye exam. Expect to spot redness, tearing, and difficulty in using the eye on initial inspection. Larger foreign bodies can be seen outright. Unless they’re substantial, abrasions might not be visible without staining. Larger foreign bodies can be identified during direct inspection, but for a closer look, especially at rust rings, a slit lamp examination is your best bet. Perform fluorescein staining after the initial exam.

For cases involving penetrating wounds, lacerations, impaired eye movements, new pupillary defects, signs of infection, loss of visual acuity (unless it’s a minor abrasion in the visual axis), and signs of iritis, a swift referral for definitive care is strongly recommended. Avoid globe palpation if there’s a penetrating wound, and opt for an eyeshield when possible. Confirm the tetanus status, and administer a booster if needed, but that’s for penetrating injuries only.

Spotting the Signs

When it comes to diagnostic clues:

For corneal abrasions, look out for linear uptake during fluorescein staining, which can be single or multiple. Keep an eye for parallel linear streaks or even a larger defect.

Foreign bodies are a bit more straightforward – you can see visible foreign matter in the eye, either upon inspection or with the help of a slit lamp. If it’s embedded or fixed, this foreign matter won’t budge with eyelid movement.

As for rust rings, these usually indicate a ferrous foreign body in the eye for at least 3-4 hours, commonly overnight. They’re often visible without magnification, but the smaller ones might require a closer look through a slit lamp examination.


Unraveling the Past

When delving into the history, it’s crucial to carefully piece together the events, understanding the duration of the condition. Pay close attention to whether high-impact circumstances were at play. Trying to gauge the impact can help in assessing the likelihood of a penetrating foreign body. For instance, activities like hammering or metal stamping carry a higher risk of penetrating trauma, whereas routine muffler work under a car with debris falling into the eye might not. The use or non-use of eye protection, such as glasses or goggles, should be probed and documented. If exposure persists, it’s generally wise to (re)recommend protective gear. Don’t forget to gather an eye history, digging into prior trauma and diseases impacting the eyes. Explore systemic diseases as well. Record any previous treatments, including whether the eye has undergone irrigation or other forms of care.

Examining the Scene

For routine checks related to simple corneal abrasions, rust rings, and foreign bodies, consider these key elements in the physical examination:

  • Check distant visual acuity, typically using the Snellen chart.
  • Inspect the appearance, delving into the sclera, conjunctiva, and blood vessels.
  • Look for signs of potential foreign bodies around the eyelids, eyebrows, and on the skin.
  • Evaluate the periorbital region.
  • Assess extraocular movements.
  • Examine pupillary reactivity, iris, and overall appearance.
  • Employ the slit lamp for a detailed examination.
  • Utilize fluorescein staining.

Additional components that might come into play for apparent work-related foreign body eye injuries include pinhole testing (especially if there’s a reduction in visual acuity), direct ophthalmoscopy, and occasionally, ocular pressure/manometry.


Diagnostic Recommendations

Evaluating Sight

When you first visit, we kick things off by screening your distance visual acuity. It’s not just a routine; it helps us grasp your current visual sharpness, shape our clinical approach, and sets a baseline for future visits. The Snellen chart, the go-to in visual acuity testing, stands as the gold standard. Normally, we conduct these tests from a 20-foot distance, but if the chart or card is closer, we adjust, using smaller letters.

Now, there’s a bunch of other acuity tests out there, like the Randot Stereoacuity test, the Early Treatment Diabetic Retinopathy Study, the Functional Acuity Contrast Test, and the Tritan Contrast Threshold test (you can explore more at They all have their merits.

Peering into Eye Conditions

When it comes to checking out your eyes after an injury involving foreign bodies or corneal abrasions, we recommend the Visual Acuity Testing. It’s like the Sherlock Holmes of eye evaluations, giving us the lowdown on how your eyes are functioning after a scuffle with foreign invaders or abrasions.

Now, let’s talk about the Slit Lamp and Fluorescein Stain duo – highly recommended for the grand reveal. The slit lamp takes the spotlight, giving us a close-up on corneal abrasions and other eye hitches. It’s also our top pick for showcasing the glow-up with fluorescein staining. It’s like our eye detective kit, revealing the secrets your eyes might be hiding.


Radiant Insights: Peering into the Depths

Ever wondered how we unveil hidden mysteries within your eyes? That’s where Roentgenograms, or X-Rays, step into the limelight. Using x-ray beams, they play detective, especially when it comes to spotting elusive metallic or calcified objects. Picture it as an initial sneak peek into your eye’s inner workings—helpful for checking structural components, from foreign bodies to fractures.

In the past, it was a go-to move, having these x-rays snap a shot of the orbits. They were the pioneers, but let’s be real, they’re not the heroes for a definitive diagnosis or detailed surgical game plans. Think of them as the opening act, setting the stage for the star of the show: the CT scan.

Now, when suspicion runs high for foreign bodies or fractures, some providers may skip the x-ray warm-up altogether and go straight to the CT scan. It’s like jumping right into the heart of the action, bypassing the preliminaries.

Exploring the X-Ray Landscape: Navigating Eye Trauma

Imagine X-rays as the pioneers on a quest to uncover secrets within your eyes—here’s how we recommend their roles:

X-Ray for Orbital Fracture Evaluation Recommended: Think of it as the opening scene in select cases, a preliminary screening tool, not the final script. Ideal for checking potential fractures and assessing eye trauma, especially if metallic mischief is involved. Indications: Trauma that packs a punch, potentially causing orbital fractures, and eye injuries linked to metallic objects.

X-Ray for Ocular Foreign Bodies Recommended: Another cameo for x-rays in select scenarios, again, not the main act. When suspicion looms large for ocular metallic visitors, these preliminary shots can be quite revealing. Indications: Jobs with high-impact tools, where penetrating projectiles are a real risk, and when there’s a hunch about metallic ocular intruders not spotted during the physical exam.

X-Ray for Simple Abrasions, Rust Rings, and Non-Metallic Foreign Bodies Not Recommended: Skip the x-ray drama for routine checks on ocular abrasions, rust rings, or non-metallic foreign bodies—they won’t steal the show here. Indications: Save x-rays for situations where simple abrasions, rust rings, or non-metallic foreign bodies aren’t likely to be captured in their frames.


Computed Tomography (CT)

CT Scans: The High-Resolution Voyagers in Eye Imaging

Enter the realm of Computerized Tomograms (CT scans), where x-rays take on a more intricate role, providing detailed images with unrivaled precision. Here’s our take on when these visual maestros should take center stage:

CT for Ocular Foreign Bodies Recommended: Save it for the spotlight, but only for select patients dealing with penetrating globe injuries, corneal abrasions with penetration concerns, or the worry of lingering intraorbital foreign bodies. Indications: It’s the go-to when you suspect something’s been lodged in the eye—specifically, penetrating injuries or corneal abrasions with potential foreign body remnants.

CT for Possible Orbital Fracture Recommended: Another starring role for CT scans, but only for specific scenarios involving penetrating globe injuries, abrasions raising concerns for undetected fractures on x-rays, or suspected complications like orbital sepsis or traumatic optic neuropathy. Indications: Use it wisely for cases with suspected fractures not visible on simple x-rays, and when fractures come with added complications, such as impaired visual function. However, for straightforward fractures without extra issues, skip the CT drama.


Magnetic Resonance Imagery (MRI)

MRI Unveiled: A Glimpse into the Eye’s Soft Landscape

Magnetic Resonance Imaging (MRI), renowned for its prowess in capturing the subtleties of soft tissues, steps into the scene, but with a few caveats:

MRI for Foreign Body and Corneal Abrasion Diagnosis Not Recommended: Keep it in the wings for routine eye foreign body or corneal abrasion evaluations, especially if there’s a suspicion of a ferrous-metallic object diving into the globe. Recommended: Let it take the spotlight selectively when dealing with non-ferrous intraocular foreign bodies, ensuring there’s no magnetic mischief lurking. It’s a go-to when fractures are in the mix, accompanied by visual concerns. Contraindications:

No entry for ferrous-metal foreign bodies—steer clear to prevent additional trauma. Indications: While it might not be the star for most ocular events, it earns its keep for soft tissue injuries. Think of MRI as your go-to for evaluating conditions like orbital fractures, unconventional foreign bodies (think wood), and trauma-induced visual impairment. A backstage pass for specific scenarios.


Treatment Recommendations

Unveiling the Art of Foreign Body Extraction

When it comes to ushering out unwelcome foreign guests from the eye’s domain, a diverse array of techniques takes center stage, each with its own flair:

Copious Irrigation for Superficial Foreign Body Farewell Recommended: Let the cleansing cascade of copious irrigation work its magic in certain scenarios, bidding adieu to superficial foreign bodies. The Morgan Lens, however, takes a backseat in uncomplicated cases, steering clear of potential (additional) abrasions. It earns its keep when chemical concerns threaten a pH imbalance or another rapid corneal injury mechanism (refer to the Chemical Conjunctivitis Guideline below). Indications: Triggered by that telltale foreign body sensation, especially when the suspects include unembedded intruders like fiberglass or windblown debris. A selective encore after foreign body eviction, especially if fragments linger. Frequency/Dose/Duration: Pour forth approximately 200mL to 1L of either sterile saline or lactated Ringer’s solution. Feel free to repeat until symptoms take their final bow.

The stage is set for a meticulous dance of removal, where magnets, swabs, needles, and tears all play their part, ensuring a smooth exit for those foreign interlopers.

Unveiling the Art of Superficial Foreign Body Liberation

Foreign Body Extraction Ballet: Act II

When the gaze falls upon a stubborn superficial foreign body, the tools of the trade transform into choreographers, each lending its rhythm to the graceful extraction ballet:

1. Needle, Tool, Magnet, or Swab – Choosing the Dance Partner Recommended: Let the choice of device—needle, tool, magnet, or swab—harmonize with the expected foreign body’s composition, embedding depth, and the clinician’s seasoned expertise. A post-extraction encore of copious irrigation (refer to the section above) ensures the thorough bowing out of foreign intruders, especially if their departure triggers fragmentation. The optional dance partner, the slit-lamp examination, takes center stage for intricate removals or when prior attempts find themselves in a tangled pas de deux. Indications: When the foreign body unveils itself—visible and nonchalantly stationary. Essential Props: A helpful dose of magnification, with the slit-lamp optional for straightforward removals where visibility reigns supreme, especially when a magnetic performance is in play.

2. Rust Ring Waltz – A Delicate Dance of Removal Recommended: As a corneal rust ring pirouettes into existence merely hours after ferrous metal’s embrace or penetration, a removal recommendation gracefully follows. Despite its insolubility in the corneal tissues, rust’s infiltration is but a temporary mark on the stage, usually swept away without much ado.

The stage is set for a symphony of removal, where tools become instruments and the clinician, a maestro orchestrating the dance of liberation.

Indications: As the curtain rises on the stage adorned with a rust ring, whether with or without a visible foreign body, the performance is set into motion. In the limelight, the removal saga commences with an earnest look at the lingering rust mark. If a foreign body takes center stage alongside the rust ring, it must gracefully bow out first. When orchestrating this opening sequence, the use of a magnet takes precedence as the initial tool, a maestro leading the dance of extraction.

For the subsequent ballet of rust ring removal, the preferred choreography unfolds under the soft glow of the slit lamp examination. Here, the burr takes center stage, pirouetting elegantly to sweep away the vestiges of rust. As a supporting actor, the hypodermic needle may find its moment in the spotlight, adequate for delicately removing petite rust rings. Each movement in this ballet of removal is a nuanced expression, ensuring a harmonious cadence in the act of liberation.

The Enigma of Eye Patching Unveiled: A Human-Centric Rendition

Eye Patching’s Historical Reverie: In the age-old chronicles of eye care, the narrative of eye patching unfolds as a venerable remedy for corneal abrasions borne from foreign invaders or the aftermath of traumatic encounters with the corneal epithelium. A time-honored tradition of prescribing a 24-hour patching regimen emerged, adorned with the lofty aims of pain reduction and the poetic notion of fostering healing by restraining the dance of eyelids over the wounded terrain. As an accompaniment to this saga, the use of an antibiotic ointment, such as Erythromycin, is often interwoven with the patching ritual.

Contact Lens Wearers at the Crossroads: However, in the intricate tapestry of ocular care, a cautionary note emerges, suggesting a detour around the path of patching for those adorned with contact lenses. The flora of their ocular realm dances to a different tune, setting them apart from their lens-free counterparts. Thus, in the realm of contact lens wearers, the curtain falls on the recommendation for patching, leaving it to wither away as a not-so-favored act in the play of eye care.



Navigating the Ocular Realm: A Humanized Retelling

Embracing Antibiotics for Ocular Comfort: In the saga of eye care, the application of ophthalmic antibiotic solutions or ointments emerges as a common prescription in the aftermath of a tumultuous encounter with corneal abrasion. While the likelihood of bacterial keratitis unfurling its cloak after such an event is perceived to be relatively low, a shadow of increased risk looms in cases entwined with the remnants of vegetative or organic matter. Interestingly, whispers in the winds of medical anecdotes suggest a higher incidence of keratitis dancing in the aftermath of foreign body dalliances in the developing world compared to the industrialized havens.

The Dual Nature of Topical NSAIDs: Transitioning into the realm of relief, topical nonsteroidal anti-inflammatory medications (NSAIDs) take the stage as local analgesics, offering solace from the pangs of pain. Yet, their dual nature surfaces, for they bear the potential to sow discord by exacerbating or even birthing corneal ulcers and intensifying the plight of corneal abrasions. This enigmatic duality prompts a cautious approach, confining their usage to the post-operative realm or the corridors of macular edema treatment. The discretion, it seems, lies in the discerning hands of the treating ophthalmologist.

Antifungal Ointments: Guardians Against Fungal Keratitis: In the realm of preventive measures, topical antifungal medications, donned in the attire of ointments, step into the limelight. Their mission: to ward off the looming specter of fungal keratitis that often emerges from the aftermath of corneal abrasions linked to unsanitary liaisons with objects or sources. A silent guardian, the antifungal ointment, seeks to weave a barrier against the fungal intruders, acting as a shield in the ocular battleground.

Prophylactic Shield for Abrasions and Intruders: In the intricate narrative of eye care, the notion of prophylactic ophthalmic antibiotics takes center stage, casting its influence over the fate of simple corneal abrasions, rust rings, and foreign bodies devoid of vegetative entanglements. However, a twist in the tale unfolds, as this protective cloak is deemed unnecessary for cases untouched by the whispers of vegetative matter.

A Vigilant Watch Over Organic Terrain: The next chapter unfolds in the realm of injuries adorned with significant organic or vegetative matter, where prophylactic ophthalmic antibiotics emerge as the guardians of ocular sanctity. Their role is paramount, urging a vigilant follow-up in the short span that follows, with the subtle warning that a swift referral to an eye specialist is warranted if the symphony of symptoms fails to find the path of improvement.

NSAID Drops: A Cautious Dance: As the tale unfolds further, the spotlight shifts to NSAID drops, offering solace after the removal of corneal rust rings or foreign bodies. Yet, a note of caution lingers, advising against their use in the realms of large abrasions, particularly those of substantial size. The evidence, it seems, points to a restrained dance of NSAID drops in the post-removal choreography.

Guardians Against Fungal Whispers: The narrative takes an intriguing turn as the talk turns to prophylactic ophthalmic antifungals. While their role in routine prophylaxis for simple corneal abrasions, rust rings, and foreign bodies is dismissed, they don the mantle of protection for select populations at risk, perhaps from the touch of plants or organic whispers.

Contact Lenses: A Rare Stint in the Ocular Saga: The final act in this ocular odyssey introduces therapeutic contact lenses, reserved for rare circumstances involving corneal abrasions, rust rings, or foreign bodies. A subtle nod to their role in the grand symphony of eye care, but one that remains rare and nuanced in its application.

Epidermal Growth Factor (EGF): A Tale Untold: In the unfolding saga of ocular care, the enigmatic character of Epidermal Growth Factor (EGF) steps into the limelight. However, the plot takes an unexpected turn as this protagonist finds no endorsement in the treatment of corneal abrasions, rust rings, and foreign bodies. The evidence, it appears, does not lend its weight to this chapter of the ocular odyssey.

Mydriatic Medications: Gazing into the Abyss: The narrative then shifts to mydriatic medications, whose role in the realm of simple corneal abrasions, rust rings, and foreign bodies is brushed aside. The evidence, it seems, refuses to grant them a leading role in this particular act.

Mydriatic Medications: A Sublime Intervention: As the tale unfolds further, mydriatic medications reclaim their place in the spotlight, albeit in the rarest of circumstances. Reserved for select photophobic patients battling severe corneal abrasions, ulcers, and other surface disorders, their role is nuanced and sparingly scripted. The evidence lends its weight to this subtle intervention in the realm of intricate ocular complexities.

Lubrication: A Balm for the Ocular Soul: The narrative then introduces artificial tears or lubrication as a comforting balm for the extensive canvases of corneal abrasions, rust rings, and foreign bodies. Recommended in select patients with corneal abrasions of substantial size and pain, these soothing drops find their place as adjunctive treatments, a tender touch in the realm of ocular healing.

Artificial Tears: A Symphony of Relief: The final act introduces artificial tears as a melodic relief for corneal abrasions, rust rings, and foreign bodies. Their use, recommended for short-term relief, extends beyond the clinical setting, becoming a harmonious note that patients may play in the comfort of their homes.

Seeking Solace in the Shadows:  In the delicate realm of ocular pain management, the spotlight turns to the use of topical opioids for analgesia in the context of corneal abrasions, rust rings, and foreign bodies. However, the plot takes an unexpected turn as the narrative unfolds – the use of topical opioids is not recommended in this particular act of the ocular saga. The evidence, it seems, casts a shadow over the role of opioids in bringing relief to the pain-laden landscapes of corneal injuries and foreign intruders.

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