Rust Ring in Eye - What is your practice?

Angry Birds

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    Do you use a needle to remove it?
    Do you have a Burr drill thingie?
    Or leave it in and refer to next day ophtho?

    I don't have a burr drill thingie and I am too scared to use a needle that close to the eye, so I refer to next day ophtho if a q-tip doesn't work (which it never does). Is this kosher? What if it's more than a rust ring but a small metallic object embedded in there?
     

    ERCAT

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      Uh, I hate eye foreign bodies. I always remove the metal, even though I hate it so much. Usually it is too deeply imbedded to use a needle so I use the burr, pooping my pants internally the whole time. If there is a rust ring I just refer those out.
       
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      bravotwozero

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        Yeah totally not comfortable fishing metal rings out with a 18 gauge needle. If it's working hours, i'll just call ophtho and have the patient discharged to their office, which they're happy to see. If it's at night, they get transferred to the mothership.
         

        BoardingDoc

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          Do you use a needle to remove it?
          Do you have a Burr drill thingie?
          Or leave it in and refer to next day ophtho?

          I don't have a burr drill thingie and I am too scared to use a needle that close to the eye, so I refer to next day ophtho if a q-tip doesn't work (which it never does). Is this kosher? What if it's more than a rust ring but a small metallic object embedded in there?
          Rust ring: refer to ophtho to deal with it as an outpt

          FB embedded on the surface: Flick it out with an 18g needle. Just stabilize your hand on their forehead/face while you do it. Not difficult.
           
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          RPedigo

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            We in our ED remove the corneal foreign body, but we are fortunate to have ophthalmology in our hospital so then we just have them follow up with our ophthalmologists in a couple of days to get the rust ring burred out. We do not typically do the rust ring removal ourselves. Rust typically migrates towards the surface in 1-2 days and is easier to remove then, so I feel like trying to remove it in the ED is (1) harder than it will be later, and (2) by someone less experienced with the technique of rust ring removal.
             

            Groove

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              I approach exactly like @BoardingDoc. I do use a slit lamp though. It's not that difficult but you need a cooperative patient. I sometimes give them some Ativan or a whiff of versed if they are a nervous Nellie.

              I never bother with rust rings in the ED and always punt to ophtho for the reasons mentioned above.

              I'm totally comfortable using burrs but I haven't had access to one since residency. Even my slit lamp is ancient where I currently work and I have to kick it a couple of times for the lights to come on.
               

              UKEMdoc

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                There’s no desperate rush for this.
                I pull out foreign bodies with a Q tip or 21gauge needle. If you work <20 miles from an ophthalmologist let them sort the rust rings in clinic.
                im happy leaving a rust ring a couple of days
                 

                Groove

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                  Did this today. Removed FB with 27 ga needle. Rust ring left behind - ophtho follow-up. Bye.

                  Way to go. I like using the 18g. I prefer the bigger needle and can many times just lay the back on top of the cornea and flick or rotate the cutting edge against the FB and almost scoop it out. 27 seems like it would be too flimsy with a really small surface area, but hey...whatever works.
                   
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                  RuralEDDoc

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                    Definitely not an emergency to remove a rust ring. Similar to extensor tendon repair, enemas in 90% of cases, bedside ultrasound about 2/3 of the time, and a lot of the other things we do.
                     
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