Removal of Corneal Foreign Bodies

Bulletin, Feb. 1994

Superficial corneal foreign bodies are a common problem. The Regulated Health Professions Act, 1991 (RHPA) and the Optometry Act bring the removal of corneal foreign bodies into question since the profession does not have the controlled act nor an exemption to the controlled act of “performing a procedure in or below the surface of the cornea.”

The result of this present statutory status is that members may continue to remove a foreign body lodged on the surface of the cornea but not in the cornea since the former procedure (clinical situation) is not a controlled act and continues to be an integral part of the practice of optometry. Accordingly, professional judgment must be exercised in differentiating those foreign bodies that are embedded below the surface of the cornea and below the level of Bowman’s membrane.

The removal of a foreign body lodged on the surface of the cornea should continue to be done in accordance with expected standards of practice which includes the taking of a history and particulars of the incident, the appropriate clinical investigation and making of a drawing or recording of the position of the foreign body, development of a management plan and advice for prophylactic care, and follow-up assessment as required, or referral to an appropriate registered health care professional.

It has been noted by the Ministry of Health that Section 29(1)(a) under the RHPA provides an exemption to S.27(1), the “controlled acts”, if a procedure “is done in the course of rendering first aid or is of temporary assistance in an emergency.”

The College agrees that this exemption would protect the member from the legal ramifications of the RHPA. However, the situation being what it is, the College would caution members that in the event of an untoward incident arising from this “first aid” or “temporary assistance” the member may find him/herself civilly liable and may not be covered by professional liability insurance. Therefore, members should check with their insurance carriers.