5.4 Foreign Body, Corneal

eyes.nhs.scot/
Eyecare Guidelines/
Section 5 - Cornea/
5.4 Foreign Body, Corneal

Date of last review:

19/12/2025

Date of next review:

19/12/2027

Date of publication:

19/1/2026

This is a GOS Specialist Supplementary condition and should be managed by community optometrists in line with national guidance⁽⁸⁾. This guideline should be read in conjunction with ‘Supporting information’ guidance [link to Supporting Information page]

Differential diagnosis ⁽¹⁾

Recurrent erosion syndrome
Sub-tarsal foreign body

Possible management by optometrist

Advice ⁽¹⁾

History is important to try and establish cause of foreign body:
- High-velocity particles → risk of globe penetration
- Metallic (ferrous) → rust ring (haemosiderosis)
- Vegetative → risk of fungal infection
Rule out multiple particles (cornea, conjunctiva, fornices); double evert lids if needed
Loose FB: irrigate with saline
Conjunctival FB: remove with sterile cotton bud
Assess depth using slit lamp; Anterior Segment OCT may help
Perform Seidel test if perforation suspected
Topical anaesthesia (e.g. proxymetacaine 0.5%, oxybuprocaine 0.4%) to be used prior to the removal of the foreign body.
Remove corneal FB with sterile needle tangentially to reduce penetration risk
- Once removed assess the size of the remaining epithelial defect, to monitor healing
Consider monitoring for signs of infection in the case of organic foreign body
Check:
- Visual acuity before and after removal
- Globe/adnexae for penetration
- Where there is any suspicion of a penetrating injury, carry out dilated fundus examination
- Anterior chamber for cells/flare
- Pupil responses
- Rust ring removal only by trained practitioners (e.g., Alger Brush)
- Ensure sterile instruments and appropriate clinical governance
- Do not pad or patch the eye
- Advise return if symptoms persist and recommend eye protection for future

Treatment

Ocular lubrication (unmedicated or medicated ointment) ⁽¹⁾. Refer to local formularies for suitable options ⁽⁶⁾
Topical antibiotic prophylaxis if infection risk (e.g. chloramphenicol 0.5%) ⁽¹⁾
For large epithelial defects: cycloplegia (e.g. cyclopentolate 1%) ⁽¹⁾
Contact lens wearers: use antibiotics effective against Gram-negative organisms (e.g. a quinolone such as ofloxacin or an aminoglycoside such as gentamicin) ⁽¹⁾
- no lens wear during treatment ⁽¹⁾
Recommend simple over the counter pain relief with advice from pharmacist if needed ^(1,7)
Topical NSAIDs - limited evidence of benefit ⁽¹⁾

Typical adult dosage/duration

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

Chloramphenicol 0.5% eye drops ^(1,5) (POM generic): One drop every 2 waking hours for 48 hours. After this period, treatment should be every 4 hours during waking 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)
Chloramphenicol 1% eye ointment ^(1,5) (POM generic): 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)
Cyclopentolate hydrochloride 1% eye drops ^(1,5) (POM generic): One drop up to 3 times daily, consider reducing (or stopping) as condition improves ^(6,7) (consult local guidance as they may vary on timescales)
Gentamicin 0.3% eye drops ^(1,5) (POM generic): One drop ⁽⁷⁾ at least every 2 waking hours, reduce frequency as infection is controlled and continue for 48 hours after healing. Frequency of eye drops depends on the severity of the infection and the potential for irreversible ocular damage; for less severe infection 3–4 times daily is generally sufficient ^(2,3)
Ofloxacin 3mg/ml eye drops ^(1,5) (POM generic): One drop ⁽⁷⁾ in the affected eye(s) every 2-4 waking hours for the first 2 days then four times daily. Treatment should not exceed 10 days ^(2,3)
Ketorolac trometamol 0.5% eye drops ^(1,6)(POM): One drop, three times daily for up to 3 weeks ^(2,3).

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

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

Further management options

GOS Specialist Supplementary Stage 1 where appropriate* ⁽⁸⁾
If required, GOS Specialist Supplementary stage 2* treatment should be provided by a local IP optometrist/OMP who is registered and qualified to carry out GOS Specialist Supplementary Stage 2 management; intra-referral (practice to practice) should take place to facilitate this ⁽⁸⁾.
Treatment may be provided within available locally enhanced schemes, or by community IP optometrists/OMPs, as appropriate (out with GOS Specialist Supplementary) ⁽⁷⁾
Superficial FB: manage to resolution, usually no referral ⁽¹⁾
Deep penetration or rust ring: emergency referral to ophthalmologist, unless optometrist is trained in rust ring removal ⁽¹⁾

*Treatment should be provided in line with “Annex C of the Statement” ⁽⁸⁾

https://www.eyes.nhs.scot/for-professionals/legislation/

Possible management in secondary care or local/community pathways where available ^(1,8)

See Further management options
Wound exploration
Removal of deep FB
Rust ring removal
Ultrasonography if intraocular FB suspected

College of Optometrists Clinical Management Guideline⁽¹⁾

Corneal (or other superficial ocular) foreign body - 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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