6 EyeWorld Asia Pacific | June 2024 Handling Persistent Foreign Body Sensation by Ellen Stodola, Editorial Co-Director “It’s difficult to guess at percentages, but I think all patients are likely to experience some form of irritation in their life including FBS. In my experience, a specific patient subgroup of roughly 10% do experience severe forms of FBS that are recalcitrant to treatment,” said D. Brian Kim, MD. The persistence of FBS implies chronicity, he said, which may include dry eye syndrome, blepharitis, or allergic conjunctivitis. Anatomical comorbidities involving the eyelid such as floppy eyelid syndrome, conjunctivochalasis, epithelial basement membrane dystrophy, and recurrent corneal erosions can exacerbate the problem as well. Rony Sayegh, MD, said that persistent FBS is when an individual experiences the sensation that there is something gritty, scratchy, or uncomfortable in their eye, even when no actual foreign object is present. The prevalence of persistent FBS can vary depending on the underlying causes and the population being studied, he said, adding that it’s a relatively common complaint that ophthalmologists encounter. He also noted dry eye as one of the most common causes, affecting a significant portion of the population. How much does cataract surgery contribute to FBS? Dr. Sayegh said that FBS of varying severity, persisting for 3 or more months after cataract surgery, seems to occur in about 10–15% of patients. Although the mechanism is not fully understood, there are a number of possible reasons for this postoperative FBS, he said. Local edema over the incision from surgical trauma is one possible factor, and microcystic edema, or even frank bullae, can be seen on exam. Hypertonic saline solution can be helpful in these cases as the edema is often transient. Persistent inflammation is another cause that is not well understood. Patients with a history of dry eye, diabetes, underlying connective tissue disease, or certain nutritional alterations may be at a higher risk. Damage to corneal nerves at the incision site is another potential cause. Severing corneal nerves can lead to alterations in the functional tear unit with decreased tear production, reflex tearing, and decreased release of Foreign body sensation (FBS) is a common issue that may be associated with a wide range of conditions, which could present with different signs and symptoms. Two physicians discussed this problem, including when they’re most likely to present and how they can be diagnosed. Local edema over the incision from surgical trauma is a possible reason for FBS after cataract surgery, and microcystic edema, or even frank bullae, can be seen on exam. Source: Rony Sayegh, MD This photo shows the thin profile of the Kim Corneal Sweeper and the well-demarcated fold in the epithelium highlighted by fluorescein dye and cobalt blue light. Source: D. Brian Kim, MD CATARACT
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