Orbital foreign body masquerading as conjunctival melanoma 60 years after injury

A 74-year-old man presented with a 6-month history of a pigmented conjunctival lesion on his left eye. The lesion was initially suspicious for conjunctival melanoma. The patient admitted to a remote history of trauma from a airgun pellet over 60 years ago. Anterior examination revealed a 6 x 6 mm pigmented left conjunctival lesion and B-scan of the lesion was suggestive of a retained orbital foreign body. The lesion was removed through a transcaruncular medial orbitomy and pathology showed a retained orbital foreign body. A newly pigmented conjunctival lesion although initially concerning for melanoma represented a retained orbital body that surfaced many years after the initial orbital trauma.