Audience

  • Highland Health and Social Care Partnership
  • Primary and Secondary Care

Foreign body: corneal/conjunctival/subtarsal

Symptoms:

Pain, foreign body sensation, decreased vision, watering

Signs:

Foreign body visible on cornea or conjunctiva, linear corneal abrasions with fluorescein (subtarsal foreign body

Management:

  • Topical anaesthetic: Proxymethacaine drops
  • Evert lid if subtarsal
  • Remove foreign body if possible

If foreign body removed:

  • Chloramphenicol ointment 4 times daily for 5 days
  • Analgesia: Topical Cyclopentolate 1% stat then Topical Diclofenac pack to take home
  • Oral analgesia as required
  • Discharge

If can’t remove foreign body:

  • Chloramphenicol ointment 4 times daily for 5 days
  • Analgesia: Topical Cyclopentolate 1% stat then Topical Diclofenac pack to take home
  • Oral analgesia as required
  • Arrange for follow up with Ophthalmology that day or, if out of hours, the following day.

Corneal abrasion

Symptoms:

Pain and photophobia, watering, decreased vision

Signs:

Corneal epithelial disturbance (but no corneal opacity) which stains well with fluorescein, red conjunctiva

Management:

  • Chloramphenicol ointment 4 times daily for 5 days
  • Oral analgesia as required
  • Other Analgesia if required: Consider Topical Cyclopentolate 1% stat and Topical Diclofenac pack to take home
  • Discharge

Arc eye

Symptoms:

  • Few hours after welding (or sunbed use)
  • Pain and photophobia, watering, decreased vision

Signs:

Red conjunctiva, mild corneal haze, diffuse punctuate corneal staining with fluorescein

Management:

  • Chloramphenicol ointment 4 times daily for 5 days
  • Analgesia: Topical Cyclopentolate 1% stat then Topical Diclofenac pack to take home
  • Oral analgesia as required
  • Discharge

Conjunctivitis

Symptoms:

Itching, burning, gritty, watery or discharging eyes

Signs:

Red and oedematous lids and conjunctiva, discharge on lashes

Management:

  • Conjunctival swab if possible
  • Chloramphenicol ointment 4 times daily for 5 days
  • Liquifilm tears 4 times daily for lubrication if required
  • Oral analgesia as required
  • Discharge

Iritis

Symptoms:

Increasing pain and especially photophobia, decreasing vision

Signs:

  • Red conjunctiva - especially adjacent to corneal limbus
  • Check cornea is normal (including with fluorescein) to exclude a corneal ulcer

Management:

  • Predforte or Maxidex hourly during day
  • Cyclopentolate 1% 3 times daily
  • Oral analgesia as required
  • Ophthalmology review in clinic within 3 days – refer by email

Sub-conjunctival haemorrhage

Symptoms:

If no trauma involved usually asymptomatic, sometimes foreign body sensation

Signs:

Blood under conjunctiva obscuring underlying sclera

Management:

  • Liquifilm tears 4 times daily for lubrication if required
  • Discharge

Editorial Information

Last reviewed: 14/02/2023

Next review date: 28/02/2026

Author(s): Ophthalmology Review Group.

Version: 1

Approved By: TAM subgroup of the ADTC

Reviewer name(s): Dr T Leslie, Consultant Ophthalmologist.

Document Id: TAM558