Corneal Burr for Rust Ring

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After a foreign body has been removed from the cornea there may be a residual rust ring. If it is not removed with a cotton-tipped applicator, one option is to remove it with a corneal burr, which is like a tiny brush for the cornea (this can also be done with a small needle). Once the eye is anesthetized, gently brush the cornea in the area of the rust ring to remove it. Re-examine the eye. If residual rust is left this can be removed later by an ophthalmologist. Treat for the corneal abrasion that occurs secondarily to this procedure. Presented by Jess Mason, MD.

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Jack B. -

I have been referring these rust rings out to ophthamology only because if in the center of the cornea, may leave corneal scarring, of which you have no defense ...any comments ?

Jess Mason -

I think that is totally reasonable. If your patient can actually get in with ophtho then anything you’re concerned about could be referred. This procedure does not have to happen in the ED.

Luc B., M.D. -

I was taught to use the drill (or brush) perpendicularly to the cornea or rust ring and not tangentially as shown in this video. Is there a good technique?

Jess Mason -

If the tip of the brush you are using is rounded then it shouldn't matter too much. The reason I prefer to approach tangentially is because I have more fine motor control. I support the hypothenar eminence of my hand on the patient's cheek in case they move and this also keeps my hand steady. By slightly rotating my wrist I can move the brush towards the cornea with very small movements. I'm sure there are other ways to do this that mechanically make sense, but this is my recommendation.

Ryan S. -

I would recommend keeping the eyelid open with the other hand.
Question: i was told once, and it seems to be true although the manual for our burr has been gone for 20 years, that they have a set resistance so that they will stop automatically if you press too hard. Sort of like an electric toothbrush as you mentioned in the video. do you know if this is true?

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