A novel technique of removal of an embedded metal wire from tarsal conjunctiva: A pediatric case report

Ocular foreign bodies are a common ophthalmic emergency, with metallic objects typically associated with industrial or occupational injuries in adults. In pediatric patients, metallic foreign bodies are considerably rare. Major proportion of ocular foreign bodies in pediatric population are usually organic (e.g wood, dust) or small objects accessible to children. The tarsal conjunctiva is an uncommon site for such injuries. A 5 year old male presented with sudden onset ocular pain, watering and foreign body sensation, after a metallic wire of approximately 5-7 centimetre (cm) length, diameter of 0.5-1 millimetre (mm), with an anterior looped end of 8 mm accidentally penetrated his right eye during play. Eyelid eversion revealed 8 mm of the anterior looped end embedded in the tarsal conjunctiva with the posterior straight end of the wire exposed. Removal was performed under sedation anaesthesia, using slow, sustained, tangential hand maneuvers with a Barraquer’s needle holder and a 25 gauge needle. Post-procedural care involved topical antibiotics, with resolution of symptoms within 48 hours. This case highlights the rarity of toy-related ocular foreign body injuries in young children and the need for timely intervention and a tailored management approach for optimum results. A bladeless approach for removal further reduces the risk of iatrogenic trauma and a significant role in lowering the risk of conjunctival scarring and intra-ocular infections in the future. Our case highlights the importance on strengthening child safety measures towards preventing accidental ocular injuries in the pediatric age group.