|Year : 1956 | Volume
| Issue : 1 | Page : 15-16
Conjunctival foreign bodies in the harvesting season
|Date of Web Publication||10-May-2008|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh S. Conjunctival foreign bodies in the harvesting season. Indian J Ophthalmol 1956;4:15-6
Bhopal, the capital of Bhopal State, between Madhya Bharat and Madhya Pradesh is surrounded by villages. The villagers daily group to the town for trade and other errands. Amidst these settings in the month of March (local harvesting period) three young villagers, each with a foreign body in the upper palpebral conjunctiva were attended to.
While reaping wheat they sustained injury to one of the eyes followed by severe pain, lacrimation, photophobia and redness. The excruciating pain brought them to the Hospital within 24 to 36 hours.
[Figure - 1]
| Notes on Foreign Bodies Extracted|| |
Case 1 : In the upper tarsal conjunctiva at the junction of the middle and the outer thirds. Point of entry 1 m.m. posterior to the sulcus sub-tarsals. Direction in which it lay was up and in. Only I m.m. of the foreign body was seen at the point of entry. A plain conjunctival forceps was used and it came out easily.
Case 2 : Nearly the same picture as in Case 1 except that only a spot of intense hyperaemia with haemorrage marked the point of entry. Palpation with a probe ascertained the presence of a foreign body and a small conjunctival cut was made before it could be pulled out.
Case 3: At the junction of the middle and the outer third 1 mm. below the upper border of the tarsus. 2 m.m. of it was lying, free. On eversion of the lid it appeared as though a fine light coloured eye lash was growing out of the convex tarsal border.
In all the three cases, superadded to the mild conjunctival injection was an area of intense hyperaemia both superficial and deep, localised within 5 to 7 mm. of the limbus from 8 to 12 o'clock. The corneae in the same segments showed epithelial clouding which at places reached almost to the centre of the cornea. Only in case 3, was seen an associated solitary spot of corneal abrasion, well stained by fluorescine and lying just inside the limbus at 7 o'clock position.
| Discussion|| |
The history and the morphology of the foreign bodies arc very suggestive that the spikes of the ripened wheat ears have been the cause.
The position and the manner in which the bits lay in the conjunctiva remind us about the relatively deficient bony protection available to an eye on its lateral side. Obviously the spikes have entered from a down and out direction. The sulcus subtarsalis being below the general plane of the conjunctiva was by-passed and the spikes got caught in the first prominent conjunctiva) portion, that came in the way, beyond the sulcus.
The lesions seen in the corneae and the adjacent portion of the bulbar conjunctivae were secondarily produced by the movement of the upper lid. In case 3 the additional solitary spot of corneal abrasion appears to be a primary one the spike hitting off that portion of the cornea on its way to its conjunctiva) abode.
The diagnosis can be baffling. Case 3 may be cited as an example. This young man came up with typical history and severe symptoms. The upper lid was everted and no foreign body was seen even with the focussed beam of light. The patient was brought to the table, surface anaesthesia instilled and a suspicious looking injected portion of the bulbar conjunctiva was palpated with a probe to exclude the presence of foreign body embedded therein. Later it was decided to explore the upper fornix. Standing at the head end, with the help of a Desmarres retractor the upper lid was everted and lifted away from the eye ball. The fornix showed nothing abnormal. At this juncture a colleague of mine, watching the procedure from another side could only notice it. Even on being shown by him the spot where to look, I remained unconvinced till I took his position and saw the fine hair protruding in relief. This was later removed with an epilation forceps.
Removal of the foreign bodies in all these cases resulted in rapid amelioration of symptoms and cure with no loss of vision.
| Summary|| |
Three cases of foreign bodies in the upper tarsal conjunctiva from wheat spikes during the harvesting season have been described with tile difficulties in the diagnosis and treatment.
[Figure - 1]