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| PHOTO ESSAY |
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| Year : 2023 | Volume
: 3
| Issue : 2 | Page : 539-540 |
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Managing a case of subconjunctival metallic foreign body
Amanjot Kaur
Cornea and Anterior Segment Service, L V Prasad Eye Institute, Kothur, Telangana, India
| Date of Submission | 28-Jul-2022 |
| Date of Acceptance | 07-Dec-2022 |
| Date of Web Publication | 28-Apr-2023 |
Correspondence Address:
Amanjot Kaur
Cornea and Anterior Segment Service, L V Prasad Eye Institute, Kothur - 509 228, Telangana
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ijo.IJO_1847_22
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 |
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 | |  |
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.
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