OP3.6 | Conjunctival Foreign Body Removal in Simulation — Summary & Reflection

KEY TAKEAWAYS

Conjunctival and subtarsal foreign bodies are common at primary care; the critical skill is separating them from penetrating injuries that must not be manipulated. Subtarsal FB → vertical linear corneal scratches on fluorescein staining → evert upper lid to find FB in subtarsal sulcus. Assessment red flags (refer, do not remove): reduced VA, peaked/irregular pupil, subconjunctival haemorrhage to posterior limit, visible uveal prolapse, high-velocity mechanism, positive Seidel test. Technique for safe primary-care removal: topical oxybuprocaine 0.4% → evert lid → remove with moistened cotton bud (or 25G needle bevel tangentially for adherent FBs) → re-check with fluorescein → topical chloramphenicol. Post-removal: topical antibiotic, light eye pad if epithelial defect, 24-hour review for rust ring (do NOT aggressively remove acutely — review at 24 hours for rotating-burr removal). Topical LA must NOT be sent home with the patient (causes anaesthetic keratopathy). Penetrating injury: pad without pressure, no drops, immediate emergency referral, patient kept supine and NBM.

REFLECT

In your skills laboratory, the technique steps are performed on a simulation model, not a real patient. Reflect: what aspects of the real clinical situation (patient anxiety, involuntary eye movement, variable lid anatomy, the need to recognise red flags rapidly) cannot be replicated in simulation? How would you compensate for this gap during your clinical postings? Write two sentences in your reflective journal about the limitations of simulation training for this skill.