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PHOTO ESSAY
Year : 2023  |  Volume : 3  |  Issue : 2  |  Page : 539-540

Managing a case of subconjunctival metallic foreign body


Cornea and Anterior Segment Service, L V Prasad Eye Institute, Kothur, Telangana, India

Date of Submission28-Jul-2022
Date of Acceptance07-Dec-2022
Date of Web Publication28-Apr-2023

Correspondence Address:
Amanjot Kaur
Cornea and Anterior Segment Service, L V Prasad Eye Institute, Kothur - 509 228, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1847_22

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  Abstract 


Keywords: Foreign body, iron, subconjunctival


How to cite this article:
Kaur A. Managing a case of subconjunctival metallic foreign body. Indian J Ophthalmol Case Rep 2023;3:539-40

How to cite this URL:
Kaur A. Managing a case of subconjunctival metallic foreign body. Indian J Ophthalmol Case Rep [serial online] 2023 [cited 2023 Jun 10];3:539-40. Available from: https://www.ijoreports.in/text.asp?2023/3/2/539/374908



A manual laborer in his 20s presented to us with foreign body sensation in the left eye (LE) for 5 days. When this injury happened, he was welding iron pieces in a workshop and was not wearing any protective eyewear. On presentation, his right eye (RE) examination was normal. In the LE, a 2-mm grayish metallic foreign body was observed nasally in the subconjunctival space. A 1-mm, closed-entry wound (circled) was seen adjacent to it [Figure 1]a. It was fluorescein negative due to history of being present for 5 days. Rest of the examination was normal. Intraocular pressure and fundus were also normal. Patient had best-corrected visual acuity (BCVA) of 20/20. He was explained the need of foreign body removal in the operation theater along with sclera exploration to rule out any scleral perforation. After peribublar anesthesia (5 ml of 1% lignocaine), the entry wound was re-explored with blunt dissection and the foreign body was found to be lying between the conjunctiva and tenon's tissue [Figure 1]b. It was removed gently with Lim's forceps and was observed to be a 2-mm-long, sharp iron object [Figure 1]c. No scleral defect was seen underneath; hence, the conjunctival tissue was reposited back and sutured with two interrupted, 8-0 Prolene (Polyprolene, blue monofilament) sutures. Patient was started on topical antibiotics (eyedrops moxifloxacin 0.5%) and topical steroids (eyedrops prednisolone acetate 1%), six times/daily. At postoperative 1 week, patient was doing well and had BCVA of 20/20. Topical steroids were tapered in weekly dosing. Patient was reassured about the resolution of subconjunctival hemorrhage at the site of removal of foreign body [Figure 1]d.
Figure 1: (a) A slit-lamp photograph showing 2-mm grayish foreign body in the subconjunctival space. An entry wound can be seen adjacent to it (circled). (b) On-table photograph showing the foreign body to be lying between the conjunctiva and tenon's tissue and (c) measuring 2 mm. (d) A 1-week postoperative slit-lamp photograph showing wound at the site of foreign body removal. Sutures are in situ with no signs of infection

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  Discussion Top


Ocular foreign bodies are one of the most common workplace injuries, especially if appropriate eyewear is not worn.[1],[2] They are most commonly caused by grinding, welding, hammering, or sawing of various objects.[3] On the basis of their location, they can cause devastating visual and functional outcomes. However, timely removal of superficial foreign bodies carries better visual prognosis.[4] Superficial conjunctival and corneal foreign bodies are of common occurrence, but subconjunctival foreign bodies are rarely reported. Only few cases have been reported so far in literature.[4],[5],[6],[7] Further, the diagnosis can be easily missed if there is granuloma formation.[7] X-rays will help in such scenarios as the depth of penetration can be judged with them.[4],[7] In our case, the foreign body was clearly visible and on clinical examination, no deeper penetration was suspected; therefore, X-ray was deferred. Also, the tangential entry of foreign body prevented its deeper penetration. Removal of foreign body with thorough exploration remains the treatment of choice as it can cause siderosis bulbi, secondary infections, and cataract formation.[8],[9] However, such patients should be thoroughly counseled for need of any additive procedures, such as pars plana vitrectomy.[10] Since our case was relatively simple, the foreign body was gently removed and patient maintained BCVA of 20/20, without developing any complications.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Cao H., Li L., Zhang M. Epidemiology of patients hospitalized for ocular trauma in the chaoshan region of China, 2001–2010. PLoS One 2012;7:e48377.  Back to cited text no. 1
    
2.
Macewan C.J. Eye injuries: A prospective survey of 5671 cases. Br. J. Ophthalmol 1989;73:888-94.  Back to cited text no. 2
    
3.
Voon LW, See J, Wong TY. The epidemiology of ocular trauma in Singapore: Perspective from the emergency service of a large tertiary hospital. Eye 2001;15:75-81.  Back to cited text no. 3
    
4.
Suman S, Kumar A, Rathod H. Subconjunctival foreign body with suspected scleral penetration. Trauma Case Rep 2022;38:100613.  Back to cited text no. 4
    
5.
Park YM, Jeon HS, Yu HS, Lee JS. A subconjunctival foreign body confused with uveal prolapse. Indian J. Ophthalmol 2014;62:730-1.  Back to cited text no. 5
    
6.
Preston M, Muma KIM. Subconjuctival foreign body mistaken for a scleral tear. Health Press Zambia Bull 2019;3:49-51.  Back to cited text no. 6
    
7.
Jaja Z, Laghmari M, Daoudi R. Scleral granuloma revealing intraocular foreign body. QJM 2015;108:251-2.  Back to cited text no. 7
    
8.
Burch PG, Albert DM. Transscleral ocular siderosis. Am J Ophthalmol 1977;84:90-7.  Back to cited text no. 8
    
9.
Sertan G, Yasar S, Muammer O, Rabia S. Cataract in low-grade uveitis due to scleral foreign body. Eur J Gen Med 2014;11:282-4.  Back to cited text no. 9
    
10.
Silvester A, Cazabon S. Scleral foreign body. Emerg Med J 2015;32:225.  Back to cited text no. 10
    


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