8 EyeWorld Asia Pacific | June 2024 tangentially against the cornea with steady indentation pressure along the entire corneal surface. The tear film enables it to glide over the cornea atraumatically.” Elaborating further on the use of the sweeper, Dr. Kim explains, “When an area of loose epithelium is encountered, it ripples up, which creates a visible fold easily seen due to the thin profile and enhanced by the fluorescein dye. Typically, the area of loose epithelium is isolated and well-demarcated. We published a study using the corneal sweeper to detect these hard-to-find corneal erosions and discovered that more than 80% of these patients experienced some improvement or resolution of symptoms after treatment.1” Management process The treatment for FBS depends on the underlying cause. Since foreign body sensation can be due to various factors, Dr. Sayegh suggested some general approaches and treatments: 1. Identify and treat the underlying condition. Remove any foreign bodies and exposed concretions, optimize the ocular surface. Treat conditions appropriately with antibiotics, antihistamines, and/or steroids. Hypertonic saline can help with corneal edema and epithelial basement membrane dystrophy. Use lid hygiene for meibomian gland dysfunction and blepharitis. Response to therapy can sometimes help determine the main underlying cause of the FBS, and optimizing that line of treatment, whether it is using plugs in patients who find artificial tears helpful or cyclosporine in patients who find steroids helpful, can increase the odds of success. 2. Place a drop of Proparacaine in the eye. Asking if that helps relieve the FBS can help diagnose corneal nerve dysfunction. Warm compresses not only help with blepharitis and meibomian gland dysfunction but seem to help reduce nerve pain as well. Autologous serum tears remain the most effective treatment for the neuropathic form of FBS and have been shown to help regenerate corneal nerves on confocal microscopy. Scleral lenses can also be helpful in some cases. 3. Avoid rubbing. Rubbing the eyes can exacerbate irritation and FBS. Dr. Sayegh has used wristbands that vibrate when patients attempt to touch their eyes (designed for trichotillomania) with some success. Persistent foreign body sensation in the eye can be caused by a variety of conditions and factors, Dr. Sayegh said. Some of the most common ones include: Dry eye syndrome: Dry eye is a broad term that includes any condition in which tears are impacted, in quantity, quality, composition, or distribution on the ocular surface. Blepharitis, meibomian gland dysfunction, and conjunctivochalasis are very common conditions that are part of the dry eye syndrome, and a gritty or sandy feeling in the eyes is commonly reported by patients with these conditions. Conjunctivitis: This includes allergies, which are very common, as well as viral conjunctivitis. Patients often report itching, irritation, redness, and the sensation of a foreign body in the eye. Everting the eyelids can be helpful in the diagnosis of these conditions to look for follicles and papillae, Dr. Sayegh said. Contact lens issues: FBS can be a symptom of a poor fit or contact lens spoilage or related to a complication of contact lens wear, such as a corneal abrasion or ulcer. It is also important to ask if wearing the contact lens helps with the FBS, which can occur in some patients, such as those with limbal stem cell deficiency. Foreign body: Sometimes a small foreign object can actually get stuck in the eye or under the eyelid, leading to FBS. “We have seen contact lenses retained for decades. One should not forget conjunctival concretions are common and can sometimes break through the surface and cause FBS,” he said. Environmental factors: Wind, smoke, dust, and other environmental factors can cause foreign body sensation. “Some of my patients who work long hours outdoors or at the grill have benefited from protective goggles,” he said. Eye strain: Prolonged periods of reading or using digital screens can cause eye strain, leading to discomfort which may include FBS. Corneal erosions: These are also a common cause of FBS and include epithelial basement membrane dystrophy and recurrent erosion syndrome. It is important to look carefully for patterns of negative staining that are indicative of these conditions, he said. Other dystrophies are often easier to diagnose based on corneal appearance. Certain systemic drugs such as novel cancer treatments can also cause corneal changes and FBS. CATARACT
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