Corneal Foreign Body Removal 
David Chenoweth, Christopher Sales, Mark Greiner, Chau Pham, Erin Shriver, Kanwal Matharu 
 
OPEN MANUAL OF SURGERY IN RESOURCE-LIMITED SETTINGS 
www.vumc.org/global-surgical-atlas 
This work is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License  
 
Introduction:  
For an approach to evaluation and decision-
making in the patient with a corneal foreign body, see 
the chapter Approach to Corneal Trauma.  
Corneal foreign bodies rarely require an 
operating room. In your setting, however, the 
operating room may offer the best lighting, 
assistance, place for the patient to lie still, and ability 
to maximize your ergonomic position and thus have 
steadier hands. See Approach to Positioning the 
Patient and the Surgeon. Absolute indications for 
performing this procedure in the operating room are 
a deep foreign body, concern for an open globe, or 
pediatric patients unable to tolerate slit lamp 
procedures. Regardless of the setting, the procedure 
is the same, and should always be performed under 
magnification. 
Corneal foreign body proceeds in the 
following steps: 
• Anesthetize the eye. 
• Lift the foreign body with a small needle, forceps, 
or Alger brush. 
• Remove the foreign body with a pair of forceps. 
 
Steps: 
1. Carefully examine the eyelids, conjunctiva, and 
finally the cornea, making note of the location 
and depth of the foreign body, and identifying 
epithelium, stroma, and endothelium.  
 
 
 
 
Corneal foreign body prior to removal. Note that it would be 
tempting to grab this foreign body with a forceps and pull it out, 
but as stated in the “Pitfalls” section this can push the foreign 
body deeper or result in more trauma to adjacent tissue. Source: 
doi: 10.4103/0019-5278.123168 
 
2. Anesthetize the surface of the eye using a topical 
anesthetic such as proparacaine hydrochloride 
0.5% (shorter lasting, less painful upon 
application) or tetracaine hydrochloride 0.5% 
(longer lasting, more painful).  
 
You can retract the upper eyelid with gentle pressure upwards 
on the forehead and eyelid with the same hand that applies the 
topical anesthetic.  
 
3. Retract the eyelids. This can be performed with 
an eyelid retractor, Desmarres forceps, or the 
surgeon’s fingertips. The rest of the procedure 
should be performed under magnification to 
avoid damaging the cornea. 
Corneal Foreign Body Removal 
David Chenoweth, Christopher Sales, Mark Greiner, Chau Pham, Erin Shriver, Kanwal Matharu 
 
OPEN MANUAL OF SURGERY IN RESOURCE-LIMITED SETTINGS 
www.vumc.org/global-surgical-atlas 
This work is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License  
 
 
As shown here, an assistant’s fingers can be used to retract the 
eyelids very well if eyelid retractors are not available. Care 
should be taken to avoid any contact with the cornea itself, 
which could result in further trauma. Source: Community Eye 
Health 2015; 28(91): 48–49 
 
 
Place the eyelid retractor below the upper and lower eyelids 
after application of the anesthetic, being careful not to cause an 
abrasion on the cornea. In this photo, the pupil has been dilated 
pharmacologically.  
 
4. Ask the patient to fixate their gaze on a distant 
target. 
5. Use a 25- or 27-gauge needle to gently lift the 
foreign body from the corneal surface. Approach 
the surface of the eye from an oblique or 
tangential angle to avoid accidental perforation. 
 
The tip of a needle gently lifts a metal foreign body from the 
periphery of the cornea. 
 
6. Carefully remove the foreign body with a pair of 
fine-tipped forceps such as Jeweler’s forceps. 
7. Reexamine the cornea for residual foreign 
material. Reassess for perforation with a final 
Seidel test, as described in the previous chapter. 
 
Appearance of the cornea seen in the first photo after removal 
of the foreign body- a wound remains after removal (Red circle). 
As described in the “Approach to Corneal Trauma” chapter, 
this wound may be deeper than Bowman’s layer and leave a 
permanent scar. However, since it is not in the visual axis, it is 
unlikely to be troublesome to the patient. 
Source: 
doi: 10.4103/0019-5278.123168 
 
8. No eye covering is necessary; however, a 
bandage contact lens may be placed if the patient 
is uncomfortable, is likely to rub the eye, and is 
reliable to follow up for lens removal. 
9. Discharge patient with broad-spectrum topical 
antibiotics for at least one week. Polymyxin 
B/trimethoprim or a polysporin ointment is 
Corneal Foreign Body Removal 
David Chenoweth, Christopher Sales, Mark Greiner, Chau Pham, Erin Shriver, Kanwal Matharu 
 
OPEN MANUAL OF SURGERY IN RESOURCE-LIMITED SETTINGS 
www.vumc.org/global-surgical-atlas 
This work is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License  
 
sufficient. If the injury involved contact lens 
wear, organic matter, or a fingernail, prescribe a 
topical fluoroquinolone. Do not prescribe topical 
steroids.  
10. Reexamine the patient in 24 hours and again in 1 
week. Antibiotics can be discontinued after 1 
week or after the epithelial defect resolves. 
 
Pitfalls 
• Failing to perform a thorough slit-lamp exam 
with Seidel test prior to the procedure can result 
in the surgeon missing additional foreign bodies, 
or even failing to diagnose a perforated globe. 
• Attempting to remove the foreign body with a 
pair of forceps before lifting the foreign body 
from the stroma of the cornea with a small needle 
can result in pushing the foreign body deeper, 
risking perforation. 
• Failing to address a foreign body promptly can 
result in scarring. If within the visual axis, scars 
may cause permanent changes in visual acuity. 
• Leaving a bandage or contact lens in the eye can 
result in a blinding microbial keratitis. 
 
David Chenoweth BA,  
Christopher Sales, MD MPH, 
Mark Greiner, MD 
Chau Pham, MD 
Erin Shriver, MD 
Kanwal Matharu MD 
University of Iowa Carver College of Medicine 
Iowa, USA 
 
August 2024 
 
 
