Tetanus booster as needed
Pain control with topical NSAIDs (e.g. diclofenac or ketorolac) or oral opioids
Conjunctival<unk> <unk> 
ED removal after topical anesthetic
Copious irrigation
Cotton-tipped swab soaked in saline
Rust ring
Metallic<unk>  bodies can create rust rings that are toxic to corneal tissue<unk> <unk>  be removed with a 30- to 25-gauge needle as below
Rust rings overlying the visual axis, however, should be managed by an ophthalmologist due to the risk of scarring in the visual field.
Rust also often reaccumulates by the next day requiring additional burring. It is therefore not necessary to remove a rust ring in the emergency department if the patient can be seen by an ophthalmologist the next day. Additionally, once the<unk> <unk>  is removed, the rust ring area softens overnight and can be more easily removed in the office the next day.
Corneal<unk> <unk> 
ED removal after topical anesthetic
May attempt irrigation and/or cotton-swab as above
30- to 25-gauge needle under slit lamp
Approach from tangential angle
Repeat Seidel test to ensure removal did not perforate cornea
Irrigate eye profusely post-removal
Consider cycloplegics (e.g. cyclopentolate or homatropine) for significant photophobia
Consider topical antibiotics for corneal involvement
Target gram-positive + pseudomonas (contact wearers)
Moxifloxacin – best ophthalmologic penetration
ED removal after topical anesthetic
Copious irrigation
Cotton-tipped swab soaked in saline
Copious irrigation
Cotton-tipped swab soaked in saline
Metallic<unk>  bodies can create rust rings that are toxic to corneal tissue<unk> <unk>  be removed with a 30- to 25-gauge needle as below
Rust rings overlying the visual axis, however, should be managed by an ophthalmologist due to the risk of scarring in the visual field.
Rust also often reaccumulates by the next day requiring additional burring. It is therefore not necessary to remove a rust ring in the emergency department if the patient can be seen by an ophthalmologist the next day. Additionally, once the<unk> <unk>  is removed, the rust ring area softens overnight and can be more easily removed in the office the next day.
ED removal after topical anesthetic
May attempt irrigation and/or cotton-swab as above
30- to 25-gauge needle under slit lamp
Approach from tangential angle
Repeat Seidel test to ensure removal did not perforate cornea
Irrigate eye profusely post-removal
Consider cycloplegics (e.g. cyclopentolate or homatropine) for significant photophobia
Consider topical antibiotics for corneal involvement
Target gram-positive + pseudomonas (contact wearers)
Moxifloxacin – best ophthalmologic penetration
Approach from tangential angle
Target gram-positive + pseudomonas (contact wearers)
Moxifloxacin – best ophthalmologic penetration
Erythromycin ointment qid x 3-5d OR
Ciprofloxacin 0.3% ophthalmic solution 2 drops q6 hours OR
Ofloxacin 0.3% solution 2 drops q6 hours OR
Sulfacetamide 10% ophthalmic ointment q6 hours
Antibiotics should cover pseudomonas and favor 3rd or 4th generation fluoroquinolones
Levofloxacin 0.5% solution 2 drops ever 2 hours for 2 days THEN q6hrs for 5 days OR
Moxifloxacin 0.5% solution 2 drops every 2 hours for 2 days THEN q6hrs for 5 days OR
Tobramycin 0.3% solution 2 drops q6hrs for 5 days OR
Gatifloxacin 0.5% solution 2 drops every 2 hours for 2 days THEN q6hrs for 5 days OR
Gentamicin 0.3% solution 2 drops six times for 5 days
Emergent ophthalmology consult
Prophylactic empiric antibiotics
Placement of rigid eye shield
Analgesia (oral NSAIDS or opioids) and antiemetics as necessary
Ocular foreign body
Acute
Nasolacrimal duct obstruction
Caustic keratoconjunctivitis^^
Orbital cellulitis
Conjunctival hemorrhage
Corneal ulcer
Conjunctival laceration