A subconjunctival foreign body confused with uveal prolapse

Area of Science:

• Ophthalmology
• Pathology

Background:

• Diagnosing subconjunctival foreign bodies (FB) can be challenging, often requiring advanced diagnostic methods beyond initial clinical assessment.
• Ocular trauma and irritation can present with symptoms that mimic more severe conditions, necessitating a broad differential diagnosis.

Observation:

• A case is presented of a 68-year-old male with a subconjunctival mass initially suspected to be uveal prolapse.
• The patient had a history of pterygium excision and worked in a plastic greenhouse, presenting with eye irritation and congestion.
• Slit-lamp examination revealed a hard, black, keratinized mass embedded under the conjunctiva at a site of focal scleral thinning.

Findings:

• Histopathological analysis of the excised mass confirmed it to be a dicotyledonous seed, a type of foreign body.
• The subconjunctival foreign body was initially misdiagnosed due to its presentation mimicking uveal prolapse.

Implications:

• Scleral thinning or signs suggestive of uveal prolapse should prompt consideration of a subconjunctival foreign body as a differential diagnosis.
• Histopathological examination of all removed, unidentified foreign bodies is essential for accurate diagnosis and appropriate patient management.
• This case highlights the importance of considering environmental exposures and less common presentations in ocular diagnostics.