Is it bad to burr sans slit lamp?

[deleted836128]

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I have always struggled with using the burr to remove a corneal foreign body using the slit lamp especially with my non-dominant hand. I don’t feel safe doing it - I feel like I don’t have as much control of my hand and I have trouble coordinating my hand with what I am seeing through the slit lamp. When I was having trouble removing foreign body the other day, the patient, who has been down this road many times, stated that “at the other ER the doctor just looked at my eye with the slit lamp and then had me lay down on the stretcher and removed it that way.” Today I had a metallic foreign body on a old dude that was a cinch to visualize with my naked eye. After checking things out in the slit lamp I just went with it. Had him lay down and I used the burr carefully and was astonished by how much easier this was. I completely removed the foreign body this way when in the past I may have been unsuccessful with the lamp and had to refer the patient to eye.

Provided you can see the foreign body you’re trying to take out, how bad is it to do it this way? I remember early on it my career I overheard a doctor who was absolutely apalled when he heard about his colleague doing it this way.

 

[Tenk]

I do it all the time then confirm with slit. It’s fine. People get upset over the stupidest crap. Ignore them.

 

[Rendar5]

I’ve removed FB with eye as visual aid plenty of times with either a needle or a wet cotton swap, but have used or had access to an eye burr

I always just leave the rust ring itself alone and leave it for ophtho at followup. Plenty of EM docs aren’t trained to remove them.

 

[deleted547339]

I’ve removed FB with eye as visual aid plenty of times with either a needle or a wet cotton swap, but have used or had access to an eye burr

I always just leave the rust ring itself alone and leave it for ophtho at followup. Plenty of EM docs aren’t trained to remove them.

I was trained to do it, but I don’t. It just doesn’t seem like an emergency.

 

[BoardingDoc]

I was trained to do it, but I don’t. It just doesn’t seem like an emergency.

Agree. Can remove FBs with a needle. Never trained to use a burr and have no incentive to learn. I just refer to ophtho.

 

[TooMuchResearch]

I've never done it without the slit lamp, but I suppose that's because it's how I did it in residency and there has been no reason to try without. I see no issue with the approach, although I think using the burr without being able to watch the corneal epithelium scrape away layer by later might stress me out.

 

[Groove]

We don’t have a burr at my current shop so I use an 18g needle under slit lamp. Def takes a steady hand and cooperative pt. When I’ve used a burr, I’ve always done it with slit. Never tried it without but I don’t see a fundamental problem if you’ve got steady hands and good eyes.

 

[RustedFox]

I hate the slit lamp.
I have never used it in the manner that you describe.
Burr the rust ring away; just don't be a mouth-breathing ogre and you're fine.

 

[deleted547339]

I hate the slit lamp.
I have never used it in the manner that you describe.
Burr the rust ring away; just don't be a mouth-breathing ogre and you're fine.

But why?

 

[RustedFox]

Why?
I just see it as unnecssary, cumbersome, time-consuming, and I hate the machine.
I could be an exception, though.
I can see corneal abrasions with my naked eye without a problem.
My wife chides me that while I'm deaf as a stone, that I can see an ant crawling down the street at nighttime in the next county.
She says: "That's your mutant power. That, and attention deficit disorder."

There's a really good Nintendo game called "Final Fantasy" (the first one).
There's a cave full of dwarves in it, in the early game.
Speaking to the dwarves will often result in them stating: "Dwarves can see in the dark."
My wife regularly refers to me as a dwarf and quotes the game.
She is night-blind, though. No joke. She does NOT drive at night.
She says "I see the lane lines, but the streaks of light that come off of them are too confusing."
When we go bowling, she hates it when they turn the lane lights off for "mood"; says she can't see the pins.

 

[miacomet]

I hate eye complaints in the ER, especially since the optometrists will see nearly anyone here same day. I do the minimum and have them follow up.

Best eye complaint ever was a guy who had received an injection for macular degeneration that day and was having severe pain and some other issues. Did he call the eye doc? No. Did he go to the ER at the eye hospital? No. He came to my ER...where we did nothing and sent him back to the eye hospital for the resident to rule out endophthalmitis.