Intrascleral nerve loop mistakenly identified as a foreign body

Area of Science:

• Ophthalmology
• Histopathology
• Pediatric Ophthalmology

Background:

• Scleral lesions in children can present diagnostic challenges.
• Pigmented lesions require careful evaluation to rule out malignancy or unusual anatomical variations.
• Foreign body sensation in the eye is a common complaint, but the etiology can vary.

Observation:

• A 5-year-old male presented with a pigmented lesion on the sclera.
• The lesion was clinically presumed to be a foreign body, likely graphite from a pencil.
• An excisional biopsy was performed for diagnosis and treatment.

Findings:

• Histopathological examination of the excised lesion was performed.
• The study identified the pigmented scleral lesion as an intrascleral nerve loop (Axenfeld).
• This finding represents a rare anatomical variation rather than a foreign body.

Implications:

• Accurate histological diagnosis is crucial for managing scleral lesions.
• Intrascleral nerve loops should be considered in the differential diagnosis of pigmented scleral findings.
• This case highlights the importance of biopsy in resolving diagnostic uncertainty in pediatric eye conditions.