Year : 1985 | Volume
: 33 | Issue : 1 | Page : 69--70
Unusually large conjunctival foreign body
SM Betharia, BR Kalra
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, India
S M Betharia
Dr. R. P. Centre AIIMS New Delhi-29
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Betharia S M, Kalra B R. Unusually large conjunctival foreign body.Indian J Ophthalmol 1985;33:69-70
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Betharia S M, Kalra B R. Unusually large conjunctival foreign body. Indian J Ophthalmol [serial online] 1985 [cited 2022 Nov 29 ];33:69-70
Available from: https://www.ijo.in/text.asp?1985/33/1/69/27340
The catalogue of the foreign bodies reported found in the conjunctival sac is endless as it is the most common accident occurring in day to day life. Many of such foreign bodies are missed during initial examination. We are reporting here a case with unusually large foreign body in the conjunctival sac which gave a feeling of the absence of the globe during the first examination and later on resulted into a gross visual loss due to optic atrophy.
B.S., 5 years old mate child presented with the complaints of marked swelling of lids both eyes along with swelling of the right side of the face for last 4 days. Child had pain, redness and discharge from the R.E. for the same duration. He was treated with intensive local and systemic antibiotics without any relief.
On examination : The child was febrile with signs of toxaemia. The right half of the face was markedly swollen and tender. There was marked swelling of both lids brawny oedema of conjunctiva with severe chemosis and purulent discharge [Figure 1]a.
The examination was carried out with the use of Desmarre's lid retractors under sedation and topical anaesthesia. After retraction of the lids, a very large bean seed came out through the upper fornix [Figure l]b. It measured 1 cm. in length [Figure l]c. The discharge from the eye was removed by lavage with saline. The brawny edema of conjunctiva which was very tense gave the impression as if globe was absent at the time of examination. The local and systemic antibiotics were started. After 5 days of this treatment the facial and lid swelling subsided. The conjunctival chemosis regressed and the globe became visible. The pupil was found to be semi dilated and sluggishly reacting to light. V.A. was C.F. close to face. Fundus examination revealed marked pallor of the disc.
In this case of large conjunctival foreign body, the diagnosis was initially missed because of difficulty in obtaining proper history in children and also because of difficulty in examination of conjunctival sac due to gross edema of lids and tense conjunctiva showing brawny edema. Whenever such gross inflammatory signs are present in the eye, the presence of foreign body in the conjunctivae sac should be ruled out by proper examination with the use of retractors. The conjunctivitis induced by the foreign body in this case (bean seed) was responsible for the brawny edema of conjunctiva and gross edema of the lids. The delayed management because of missed initial diagnosis can be disastrous for the visual functions as seen in this child which later showed presence of optic atrophy. This is basically caused due to mechanical pressure of large foreign body on the globe associated with tense conjunctiva and hard swollen lids. Another possibility could be toxic retrobulbar neuritis giving rise to optic atrophy later on.
Unusually large foreign body in the form of a bean seed of 1 cm. length has been reported. The presence of tense swelling of the lids with brawny edema of conjunctiva along with purulent discharge should lead one to suspicion of conjunctival foreign body failing which the gross deterioration of vision can result.
|1||Duke Elder, S., 1972, System of Ophthalmology, Vol. XIV, part 1, Henry Krympton, p. 455.|