- Abnormalities of the Pupil
- Atopic Keratoconjunctivitis (AKC)
- Basal cell carcinoma (BCC) (periocular)
- Blepharitis (Lid Margin Disease)
- CL-associated Papillary Conjunctivitis (CLAPC), Giant Papillary Conjunctivitis (GPC)
- Cellulitis, preseptal and orbital
- Chalazion (Meibomian cyst)
- Concretions
- Conjunctival pigmented lesions
- Conjunctival scarring
- Conjunctivitis (Acute Allergic)
- Conjunctivitis (bacterial)
- Conjunctivitis (viral, non-herpetic)
- Conjunctivitis (seasonal & perennial allergic)
- Conjunctivitis, Chlamydial
- Conjunctivitis medicamentosa (also Dermatoconjunctivitis medicamentosa)
- Corneal (or other superficial ocular) foreign body
- Corneal Transplant Rejection
- Corneal abrasion
- Corneal hydrops
- Dacryocystitis (acute)
- Dacryocystitis (chronic)
- Dry Eye (Keratoconjunctivitis Sicca, KCS)
- Ectropion
- Endophthalmitis (post-operative) (Exogenous endophthalmitis)
- Entropion
- Episcleritis
- Facial palsy (Bell's Palsy)
- Fuchs Endothelial Corneal Dystrophy (FECD)
- Glaucoma (chronic open angle) (COAG)
- Herpes Simplex Keratitis (HSK)
- Herpes Zoster Ophthalmicus (HZO)
- Hordeolum
- Keratitis (marginal)
- Keratitis, CL-associated infiltrative
- Microbial keratitis (Acanthamoeba sp.)
- Microbial keratitis (bacterial, fungal)
- Molluscum contagiosum
- Nasolacrimal duct obstruction (nasolacrimal drainage dysfunction)
- Ocular hypertension (OHT)
- Ocular rosacea
- Ophthalmia neonatorum
- Photokeratitis (Ultraviolet [UV] burn, Arc eye, Snow Blindness)
- Phthiriasis (pediculosis ciliaris)
- Pigmented fundus lesions
- Pinguecula
- Post-operative suture breakage
- Primary Angle Closure / Primary Angle Closure Glaucoma (PAC / PACG)
- Pterygium
- Recurrent corneal epithelial erosion syndrome
- Retinal Vein Occlusion
- Scleritis
- Steroid-related Ocular Hypertension and Glaucoma
- Sub-conjunctival haemorrhage
- Sub-tarsal foreign body (STFB)
- Trauma (blunt)
- Trauma (chemical)
- Trauma (penetrating)
- Trichiasis
- Uveitis (anterior)
- Vernal Keratoconjunctivitis
- Vitreomacular Traction and Macular Hole
- How to use the Clinical Management Guidelines
Sub-tarsal foreign body (STFB)
Contents
Aetiology
Patient may give history of foreign body entering eye
- particle falling into eye (rust while working under car, DIY debris)
- wind blown from unknown source
Predisposing factors
Lack of suitable eye protection
Symptoms of sub-tarsal foreign body
Foreign body sensation / acute pain (worse on blinking)
Lacrimation
Red eye
Signs of sub-tarsal foreign body
Possible fluorescein staining of cornea
- foreign body tracks, often vertical
Embedded material on tarsal conjunctival surface
Hyperaemia
Differential diagnosis
Dendritic ulcer
Corneal abrasion (e.g. from contact lens) (see Clinical Management Guideline on Corneal Abrasion)
Superficial punctate keratopathy of another cause
NB: check cornea for adherent/embedded material
Management by optometrist
Practitioners should recognise their limitations and where necessary seek further advice or refer the patient elsewhere
GRADE* Level of evidence and strength of recommendation always relates to the statement(s) immediately above
Non pharmacological
Evert upper eyelid
Remove foreign body, after instillation of topical anaesthetic, with:
- saline irrigation
- sterile saline-wetted cotton bud (can also be used to sweep the fornix)
- sterile hypodermic needle if cannot be dislodged by cotton bud
(GRADE*: Level of evidence=low, Strength of recommendation=strong)
Advise patient to return/seek further help if symptoms persist
Advise on future suitable eye protection
(GRADE*: Level of evidence=low, Strength of recommendation=strong)
Pharmacological
Local anaesthetic (e.g. g. oxybuprocaine 0.4%) to aid examination and removal of foreign body
(GRADE*: Level of evidence=low, Strength of recommendation=strong)
- After removal, prescribe tear supplements / lubricants for symptomatic relief
(GRADE*: Level of evidence=low, Strength of recommendation=strong)
- Consider prophylactic antibiotic (e.g. course of chloramphenicol drops/ointment for not less than 5 days) if there is substantial epithelial loss or foreign matter contamination of the conjunctival sac (see Clinical Management Guideline on Corneal Abrasion)
(GRADE*: Level of evidence=low, Strength of recommendation=weak)
Management category
B3: Management (including drugs) to resolution. Normally no referral.
Possible management by ophthalmologist
(Normally no referral)
Evidence base
*GRADE: Grading of Recommendations Assessment, Development and Evaluation (www.gradeworkinggroup.org)
Sources of evidence
Eye trauma. 2019 BMJ Best Practice
Summary
What is Sub-tarsal Foreign Body?
Sometimes a speck of dust or other debris, landing on the eye, becomes trapped under the upper eyelid. While there it may cause discomfort which increases on blinking when the foreign body is rubbed over the eye surface. Usually the patient will know that something has blown into the eye.
How is Sub-tarsal Foreign Body managed?
The optometrist will turn the upper eyelid over and, if a foreign body is found, remove it. Sometimes a drop of local anaesthetic is needed to reduce the discomfort of this procedure. Generally, no further treatment is needed, but if there is a large abrasion of the surface of the cornea (the clear window at the front of the eye) or any evidence of infection, a course of local antibiotic drops or ointment may be prescribed. Such cases are not usually referred to the ophthalmologist.
Sub-tarsal foreign body (STFB)
Version 12
Date of search 17.11.21
Date of revision 09.05.22
Date of publication 14.09.22
Date for review 16.11.23
© College of Optometrists
- Abnormalities of the Pupil
- Atopic Keratoconjunctivitis (AKC)
- Basal cell carcinoma (BCC) (periocular)
- Blepharitis (Lid Margin Disease)
- CL-associated Papillary Conjunctivitis (CLAPC), Giant Papillary Conjunctivitis (GPC)
- Cellulitis, preseptal and orbital
- Chalazion (Meibomian cyst)
- Concretions
- Conjunctival pigmented lesions
- Conjunctival scarring
- Conjunctivitis (Acute Allergic)
- Conjunctivitis (bacterial)
- Conjunctivitis (viral, non-herpetic)
- Conjunctivitis (seasonal & perennial allergic)
- Conjunctivitis, Chlamydial
- Conjunctivitis medicamentosa (also Dermatoconjunctivitis medicamentosa)
- Corneal (or other superficial ocular) foreign body
- Corneal Transplant Rejection
- Corneal abrasion
- Corneal hydrops
- Dacryocystitis (acute)
- Dacryocystitis (chronic)
- Dry Eye (Keratoconjunctivitis Sicca, KCS)
- Ectropion
- Endophthalmitis (post-operative) (Exogenous endophthalmitis)
- Entropion
- Episcleritis
- Facial palsy (Bell's Palsy)
- Fuchs Endothelial Corneal Dystrophy (FECD)
- Glaucoma (chronic open angle) (COAG)
- Herpes Simplex Keratitis (HSK)
- Herpes Zoster Ophthalmicus (HZO)
- Hordeolum
- Keratitis (marginal)
- Keratitis, CL-associated infiltrative
- Microbial keratitis (Acanthamoeba sp.)
- Microbial keratitis (bacterial, fungal)
- Molluscum contagiosum
- Nasolacrimal duct obstruction (nasolacrimal drainage dysfunction)
- Ocular hypertension (OHT)
- Ocular rosacea
- Ophthalmia neonatorum
- Photokeratitis (Ultraviolet [UV] burn, Arc eye, Snow Blindness)
- Phthiriasis (pediculosis ciliaris)
- Pigmented fundus lesions
- Pinguecula
- Post-operative suture breakage
- Primary Angle Closure / Primary Angle Closure Glaucoma (PAC / PACG)
- Pterygium
- Recurrent corneal epithelial erosion syndrome
- Retinal Vein Occlusion
- Scleritis
- Steroid-related Ocular Hypertension and Glaucoma
- Sub-conjunctival haemorrhage
- Sub-tarsal foreign body (STFB)
- Trauma (blunt)
- Trauma (chemical)
- Trauma (penetrating)
- Trichiasis
- Uveitis (anterior)
- Vernal Keratoconjunctivitis
- Vitreomacular Traction and Macular Hole
- How to use the Clinical Management Guidelines
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