A Well-Disguised Foreign Body

An 83-year-old female presented to the clinic for a routine ocular health examination. She was asymptomatic for any foreign body sensation. Her ocular health was remarkable for bilateral pseudophakia and a pterygium excision with autologous graft in the left eye. Her systemic health was unremarkable.

She was taking an 81 mg aspirin daily and a calcium-vitamin D supplement. 

Physical examination. There was a pterygium encroaching over the nasal aspect of the right eye. Upon closer inspection with a slit lamp, a cilium could be seen captured between the cornea and the pterygium (Figure). In this case, the foreign body was nearly missed because of its close resemblance to one of the pterygium’s blood vessels. 

Discussion. Before removing the cilium, 1 drop of topical proparacaine was instilled in the eye. With slit lamp magnification, a fine forceps was used to reach underneath the pterygium and remove the cilium without complication. 

Most pterygia are adherent to the cornea at their apex and to the sclera at their base. There is often a free space between the pterygium and the cornea. This free space can be accessed beneath the lateral walls of the pterygium since they are not attached to the cornea. This explains how the cilium migrated underneath the pterygium. 

Outcome of the case. Knowing this anatomical variant made it easy to access the cilium with forceps without having to do any incisions into the pterygium or the cornea.