Intraocular foreign body presenting as recalcitrant hypopyon anterior uveitis

A 38-year-old male with a history of trauma presented to us with pain and decreased vision in the left eye (LE). Previously, the patient had been diagnosed with hypopyon uveitis and was prescribed topical steroids. We performed slit-lamp examination of the LE and found exudates in the anterior chamber (AC) extending from 6 to 9 o'clock, along with circumciliary congestion and pigmented keratic precipitates. We made a diagnosis of infectious anterior hypopyon uveitis; however, all of its causes were ruled out upon the necessary investigations, which returned normal results. The patient was started on topical and oral antibiotics, and subsequently, there was complete hypopyon resolution. Five months later, he presented with similar complaints. An examination revealed a black elevated lesion in the AC at 8 o'clock suspicious of an intraocular foreign body (IOFB), along with 1 mm hypopyon. An X-ray orbit examination confirmed the IOFB presence, and the IOFB was surgically removed from the AC. Three weeks after this surgery, the patient presented with a recurrence of similar symptoms. The nasal pterygium adjacent to the location of the previously removed IOFB was inflamed with an underlying black elevated limbal nodule, which was determined to likely be a remnant of the IOFB in the subconjunctival space. Here, we report a case of penetrating IOFB that was initially detected in the AC. Its remnant extraocular component persisted in the subconjunctival space, and its incomplete removal led to recurrent inflammation.