Organic foreign body embedded under upper eyelid

ICD-10 Diagnosis Codes:

T15.11XA–Foreign body in conjunctival sac,right eye, initial encounter
T15.11XD–Foreign body in conjunctival sac, right eye, subsequent encounter
T15.11XS–Foreign body in conjunctival sac, right eye, sequela
T15.12XA–Foreign body in conjunctival sac, left eye, initial encounter
T15.12XD–Foreign body in conjunctival sac, left eye, subsequent encounter
T15.12XS–Foreign body in conjunctival sac, left eye, sequela

Foreign Body in Conjunctival Sac

Foreign Body On External Eye

Conjunctival foreign body occurs when foreign material becomes lodged on or in the bulbar conjunctiva or the palpebral conjunctiva.

Conjunctival foreign bodies may be classified by material and the most common include the following:

  • Metal
  • Plastic
  • Glass
  • Organic material

Structural Damage to the Eye

  • Inflammatory cascade begins with damage to the conjunctival epithelium
  • Inflamamtory mediators produce dilation of conjunctival blood vessels
  • Mechanical trauma produces edema of the eyelids
  • Conjunctival edema develops

Functional Damage to the Eye

  • None

The main goal of the diagnostic evaluation in a patient with conjunctival foreign body is to accomplish the following:

  • Ensure that a foreign body is the cause of the chief complaint
  • Relieve ocular pain and discomfort
  • Perform a preoperative assessment before removing the foreign body

Patient History

Patients with conjunctival foreign body may present with the following signs and symptoms:

  • Blepharospasm
  • Excessive watering of the eye
  • Photophobia
  • Conjunctival injection
  • Mild foreign body sensation to severe pain
  • Inability to localize the source of the foreign body sensation

Clinical Appearance of the Cornea

  • Look for epithelial damage
  • Evaluate with fluorescein dye
Corneal abrasion secondary to embedded conjunctival foreign body

  • Vertically-oriented tracts are associated with foreign bodies under the upper eyelid
  • Treat the corneal abrasion as required to prevent infection
Corneal abrasion secondary to embedded conjunctival foreign body

  • Corneal abrasion superotemporally
  • Associated sectoral conjunctival hyperemia


Corneal abrasion secondary to embedded conjunctival foreign body

  • Corneal defect enhanced with fluorescein dye
  • Superotemporal epithelial defect suggests a retained foreign body under the upper eyelid


Clinical Appearance of the Conjunctiva

  • Look for hyperemia
  • Evaluate with fluorescein dye
Conjunctival hyperemia secondary to embedded foreign body

  • Sectoral hyperemia
  • Clinically significant asymmetry
Embedded conjunctival foreign body

  • Eyelid eversion reveals a retained foreign body under the upper eyelid
  • Organic foreign body removed with moistened cotton-tipped applicator

There is no standard classification system for conjunctival foreign bodies.  In a general sense, they can be classified by the type of material (e.g., glass, plastic, metal, wood, etc.) and/or by the depth of the object:

  • Superficial foreign body
  • Embedded foreign body

Patients with conjunctival abrasions and patients with conjunctival foreign bodies share a common history in that both groups have a history of recent ocular trauma.

Conjunctival Abrasion

  • No apparent conjunctival foreign body
  • The affected region of the conjunctiva stains with fluorescein dye
  • Adjacent conjunctival blood vessels are dilated

The primary goals of treating a patient with a conjunctival foreign body includes the following:

  • Determine the number of foreign bodies (single or multiple)
  • Identify the location (superior palpebral conjunctiva, bulbar conjunctiva, or inferior palpebral conjunctiva)
  • Assess the degree of embeddedness of the foreign body
  • Removal of foreign body

The use of topical ophthalmic anesthetic solution is avoided unless the patient is very uncomfortable and exhibits significant blepharospasm, or if the foreign body is substantially embedded.  Topical anesthesia is avoided so that when the particle is located and removed, the patient will feel immediate relief, indicative that no foreign bodies remain in the eye.  

On occasion the foreign body may irritate the cornea sufficiently so that, even following removal, the eye is still sensitive and uncomfortable.  A thorough slit lamp examination with lid eversion will confirm that no other foreign bodies remain in the eye.  If necessary, topical ophthalmic anesthetic solution is used to maximize patient comfort during the procedure.

1.  Dahl A.  Conjunctival Foreign Body Removal.  Medscape. 8 Aug 2013.  Last accessed August 8, 2014.