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In suspected corneal foreign body should local anaesthetic be applied before or after eye examination?

Three Part Question

In [a patient presenting with a suspected corneal foreign body] is [instillation of anaesthetic drops before eye examination better than installation after eye examination] at [allowing identification and removal of any foreign bodies]?

Clinical Scenario

A 47-year-old man presents complaining of a painful gritty sensation within his left eye. He had been taking down a ceiling in his house and had not been wearing eye protection. You suspect a corneal foreign body. You are about to instil local anaesthetic drops when your registrar suggests that this is not necessary since, if there is a foreign body and it is subtarsal it could be removed without the need for the drops. She points out that installation of local anaesthetic drops is not without risk. You wonder if there is any evidence to support her pragmatic view.

Search Strategy

Medline using the NHS Evidence interface 1946 to present date of searching 14/04/15: exp EYE FOREIGN BODIES/ AND exp ANESTHESIA, LOCAL/ OR exp ANESTHETICS, LOCAL/ OR local adj2 anaesthe$.ti,ab.

EMBASE using the NHS Evidence interface 1974 to present date of searching 14/04/15: exp INTRAOCULAR FOREIGN BODY/ OR exp LOCAL ANESTHETIC AGENT/ OR exp ANESTHESIA, LOCAL OR OR local adj2 anaesthe$.ti,ab.

The Cochrane Library Issue 4 of 12 April 2015: ((MeSH descriptor: [Eye Foreign Bodies] explode all trees OR MeSH descriptor: [Eye Injuries] explode all trees) AND MeSH descriptor: [Anesthesia, Local])) explode all trees.

Search Outcome

Eighty-three unique records were identified of which none addressed the clinical question.


The use of local anaesthetic in the gritty eye with a suspected foreign body prior to examination is common to give patients quick symptomatic relief. However, there is no evidence whether this should be done before or after eye examination.

Clinical Bottom Line

There is no evidence available to answer the clinical question. Local advice should be followed.