Occult Foreign Body of the Eyelid Presenting as Recurrent Eyelid Ecchymosis

Treatment strategies for treating periocular retained foreign bodies depend on the nature of the foreign body, its composition, size, location, and presenting symptoms. Foreign bodies retained in the ocular adnexa can be asymptomatic and lie dormant for long periods of time. In this communication, we present the case of a 32-year-old female who presented with a history of multiple episodes of recurrent edema and ecchymosis of the left lower eyelid, occurring over the past three years. She had been involved in a vehicular accident 13 years ago, which resulted in multiple facial lacerations. She subsequently underwent primary wound repair and two skin grafting procedures. Imaging revealed a hyperdense foreign body located just within the inferolateral orbital rim. An exploration was performed, and a glass foreign body was recovered. We hypothesize that the dormant foreign body had migrated, and repeated microtrauma caused by the sharp edges of the glass piece, either spontaneous or triggered by trivial trauma such as eye rubbing, led to episodes of eyelid hemorrhage and edema. The unique aspects of this case are the unusually long period of quiescence before which the symptoms appeared, the atypical clinical signs, and the eventual recovery of this occult foreign body from the eyelid. This case also underscores the importance of a detailed history and the need for imaging in facial trauma.