3.20 Foreign Body, Sub-Tarsal

eyes.nhs.scot/
Eyecare Guidelines/
Section 3 - Conjunctiva/
3.20 Foreign Body, Sub-Tarsal

Date of revision:

21/09/2026

Date of next review:

21/09/2026

Date of publication:

26/10/2026

Differential Diagnosis ⁽¹⁾

Conjunctival concretion
Corneal abrasion (including abrasion secondary to a contact lens foreign body or trichiasis)
Superficial punctate keratopathy from other causes

Possible management by optometrist

Advice ⁽¹⁾

Examine the cornea carefully for any adherent or embedded foreign material
Perform upper lid eversion to identify retained foreign bodies; double eversion may be required where suspicion remains high
Following removal, advise the patient to:
- Return for reassessment if symptoms persist or worsen
- Use appropriate eye protection during future activities with risk of ocular injury

Treatment

Topical anaesthetic may be used ONLY to facilitate examination and foreign body removal ⁽¹⁾

Foreign Body Removal:

Following instillation of a topical anaesthetic, removal may be achieved using:
- Sterile saline irrigation ⁽¹⁾
- A sterile saline‑moistened cotton bud ⁽¹⁾
  - Can also be used to sweep the fornices where indicated ⁽¹⁾
- A sterile hypodermic needle and/or fine forceps if the foreign body cannot be removed by simpler methods ⁽¹⁾
  - Approach eye with needle oriented tangentially to reduce penetration risk ⁽⁷⁾
Following Removal:
- Ocular lubricants for symptomatic relief as required (drops/gel for use during the day ± unmedicated ointment for use at bedtime) ⁽⁷⁾. Refer to local formularies for suitable options ⁽⁶⁾
- Consider prophylactic topical antibiotic treatment (e.g. chloramphenicol drops or ointment) where ⁽¹⁾:
  - There is significant epithelial trauma
  - The conjunctival sac has been contaminated by foreign material

Typical dosage/duration

(Blue text = IP, black text = non-IP)

Chloramphenicol 1% eye ointment ^(1,5)(POM, off-label): Apply at night (if eye drops used during the day), alternatively apply 3–4 times daily, if ointment used alone. The course of treatment should be 5 days (even if symptoms improve)^(2,3) 
Chloramphenicol 0.5% eye drops ^(1,5)(POM, off-label): One drop every 2 (waking ⁽⁷⁾) hours for 48 hours. After this period, treatment should be every 4 (waking⁽⁷⁾) hours. Eye drops may be supplemented by 1% ointment at night. The course of treatment should be 5 days (even if symptoms improve)^(2,3)

NB. Chloramphenicol 0.5% eye drops and 1% eye ointment are available via the NHS Pharmacy First service for the treatment of infected eye conditions only and not for prophylactic use in this condition. Where prophylactic antibiotic treatment is clinically indicated, chloramphenicol can be supplied by a prescription or written order. In an emergency situation chloramphenicol (0.5% & 1%) can be supplied to the patient from practice stock if there is no alternative as above ⁽⁷⁾.

Regimens should be adjusted according to severity and patient factors (e.g. age, weight, pregnancy, renal function). Prescribing should follow local formulary and national guidance where available ⁽⁷⁾

In cases of known sensitivities, please consult local formularies for alternative options ⁽⁷⁾

Further management options

Treatment may be provided within available locally enhanced schemes, or by community IP optometrists/OMPs, as appropriate ⁽⁷⁾
Foreign body removal and ongoing management may be undertaken within primary eye care ⁽¹⁾
Referral is not normally required, provided the foreign body can be safely removed and symptoms resolve as expected ⁽¹⁾

Possible management in secondary care or local/community pathways where available

See Further management options⁽¹⁾
Referral is not normally required ⁽¹⁾

College of Optometrists Clinical Management Guideline⁽¹⁾

Sub-tarsal foreign body (STFB) - College of Optometrists *

*With special thanks to The College of Optometrists for providing the evidence framework for diagnosis and management from the Clinical Management Guidelines (CMGs) for this condition. All references to the College/CMGs are included where appropriate and form the basis of the Community Eyecare Guidelines.

Guidance is informed by the following sources

College of Optometrists Clinical Management Guidelines Clinical Management Guidelines - College of Optometrists
Advisory alignment with the College of Optometrists Formulary Optometrists' Formulary - College of Optometrists
Advisory alignment with the BNF BNF (British National Formulary) | NICE
Advisory alignment with the Summary Product Characteristics taken from the EMC Home - electronic medicines compendium (emc)
Advisory alignment with Scottish Health Board formularies (where a clear majority is present) *
Advisory alignment with expert consensus (CEGG), informed by sources 2-5 above
Advisory alignment with expert consensus (CEGG)
“Annex C of the Statement” https://www.eyes.nhs.scot/for-professionals/legislation/

* Scottish formularies should be available within the Prescribing section of your Health Board pages on the eyes.nhs.scot website. If unavailable, contact your local Health Board for further information; Health Boards landing page

If you have a query relating to this page, please email NSS.ComEyecareGuidelineGroup@nhs.scot

Disclaimers

CEG disclaimer for guidelines awaiting update:

The Eyecare Guidelines area of the eyes.nhs.scot website (“Website”) is intended as a reference source for education and clinical decision support and is intended for use by ophthalmic healthcare professionals working in Scotland.

As such, the Eyecare Guidelines are not intended for use by the general public and do not replace the advice of a healthcare professional. Members of the public should seek advice directly from their optometrist.

Before reading the Eyecare Guidelines or making any management decisions based upon them, all users should read the ‘supporting information’ page which gives more detail around the content of the Guidelines and useful website links [link to Supporting Information page].

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Users should note that that the Eyecare Guidelines guidance is not mandatory. The guidelines will not be suitable for every situation and they are not intended to be a substitute for specialist expertise and clinical judgement. Users assume all responsibility for using/interpreting the information within the Eyecare Guidelines section of the website. Users should also note that the Eyecare Guidelines should not be adhered to in isolation and should be considered in conjunction with other national and locally available guidance/pathways. 

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