A 40-year-old welder presents 24 hours after a metallic foreign body struck the cornea. Slit-lamp shows a small retained ferrous foreign body on the corneal stroma with a surrounding brownish rust ring. What is the most appropriate immediate management?

• A Leave it in situ; the rust ring will spontaneously resorb
• B Refer immediately for penetrating keratoplasty
• C Apply topical antibiotics alone and review after one week
• D Remove the foreign body at the slit-lamp and evacuate the rust ring with an Alger brush or burr ✓

Explanation

A retained corneal metallic foreign body with a rust ring requires slit-lamp removal of both the fragment and the rust ring using an Alger brush or dental burr to prevent persistent inflammation, staining, and scarring. Delayed removal leads to deeper rust infiltration. Topical antibiotics and cycloplegics are adjunctive, but evacuation is the definitive step.

Reference: AAO BCSC Section 8: External Disease and Cornea, 2023-2024 ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.