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| PHOTO ESSAY |
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| Year : 2023 | Volume
: 3
| Issue : 1 | Page : 221 |
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Scan, catch, and hold: Graphite foreign body removal
Mona Bhargava, Raj S Paul, Karan R Nathani
Department of Cornea, Refractive, Ocular Surface Services, Sankara Nethralaya, Kolkata, West Bengal, India
| Date of Submission | 03-Aug-2022 |
| Date of Acceptance | 07-Oct-2022 |
| Date of Web Publication | 20-Jan-2023 |
Correspondence Address:
Mona Bhargava
Aditya Birla Sankara Nethralaya, 147, Mukundapur, EM Bypass, Kolkata – 700 099, West Bengal
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ijo.IJO_1905_22
Keywords: Anterior segment optical coherence tomography (ASOCT), graphite foreign body (pencil lead)
How to cite this article:
Bhargava M, Paul RS, Nathani KR. Scan, catch, and hold: Graphite foreign body removal. Indian J Ophthalmol Case Rep 2023;3:221 |
A 7-year-old child presented with pain, redness, and diminution of vision in the left eye (LE) following trauma with a pencil a week ago. On examination, LE's best corrected visual acuity was 20/60 with the intra-stromal foreign body at 9'o clock paracentral [Figure 1]a with the iris tissue adherent to it with forced seidels negative. Fundus examination of both eyes was within normal limits. Anterior segment optical coherence (ASOCT) was performed to assess the depth as the child was not very cooperative on slit-lamp examination, which showed a foreign body breaching the Descemet membrane (DM) [Figure 1]b. The patient was taken up for foreign body removal under general anesthesia. Intra-operatively, the graphite foreign body (i.e., pencil lead) [Figure 1]c and [Figure 1]d was held using end gripping, and a basket forceps was used to encompass it. The corneal wound was secured with 10-0 interrupted nylon sutures. Post-operatively, the patient was started on topical steroids and antibiotics. Despite the delayed presentation, there was no evidence of infection as graphite is an inert material. | Figure 1: (a) Anterior segment slit-lamp photography of LE showing a foreign body in the slit section. (b) High-resolution cross-sectional image (AS-OCT) of the LE showing a foreign body breaching the Descemet's membrane. (c) Intra-operative photograph of LE showing removal of a graphite foreign body by basket forceps. (d) Measurement of a foreign body on the metric scale
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| Discussion | |  |
Among the ocular traumas, corneal foreign bodies are the second most common type of ocular injury, accounting for approximately 30.8 % of all eye injuries.[1] Although the diagnosis and management of corneal foreign body (CFB) is generally easily made based on the history and slit-lamp examination, some unusual cases create difficulties in the diagnosis and choosing the most appropriate method of removal.[2],[3],[4] ASOCT provides high-resolution cross-sectional images of CFBs and has the advantage of being a non-contact imaging system causing minimal discomfort, especially in trauma patients.[5] ASOCT is a useful tool to decide not only the urgency of FB removal but also the best approach for the same. Our case was successfully managed on the lines of ASOCT findings; therefore, ASOCT is an indispensable and invaluable tool.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | McGwin G Jr, Owsley C. Incidence of emergency department-treated eye injury in the United States. Arch Ophthalmol 2005;123:662-6.  |
| 2. | Girgis R, Verma S. Unusual corneal foreign body. Eye (Lond) 2009;23:1609. |
| 3. | Al-Ghadeer HA, Al-Assiri A. Identification and localization of multiple intrastromal foreign bodies with anterior segment optical coherence tomography and ocular Pentacam Int Ophthalmol 2014;34:355-8. |
| 4. | Portero A, Carreño E, Galarreta D, Herreras JM. Corneal inflammation from pine processionary caterpillar hairs. Cornea 2013;32:161-4. |
| 5. | Celebi AR, Kilavuzoglu AE, Altiparmak UE, Cosar CB, Ozkiris A. The role of anterior segment optical coherence tomography in the management of an intra-corneal foreign body. Springerplus 2016;5:1559. |
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