Occult Perforating Corneal Injury from Mechanical Pencil Graphite

Abstract

An 11-year-old boy was struck in the left eye with a mechanical pencil in a projectile manner. Initial examination under the operating microscope revealed a presumed partial-thickness corneal injury with a retained 8-mm long segment of graphite lead. After removal of the graphite segment, a full-thickness hole in the cornea was revealed under the lead shaft. The proposed mechanism of injury and unique presentation was initial full-thickness penetration followed by lead shaft retraction (likely due to eye rubbing) and then corneal stromal reentry with stromal lamellar dissection and fixation. Prompt removal of the foreign body, corneal laceration repair, and early cataract extraction resulted in postoperative 20/40 uncorrected visual acuity. Mechanical lead pencil injuries represent a unique mechanism of penetrating trauma.

Asymptomatic Intracorneal Graphite Deposits following Graphite Pencil Injury

“…There are only nine reports of injury to the eye with graphite pencil lead in literature [ 4 – 10 ]. Graphite is generally known to remain inert in the eye [ 4 ].…”

Untitled

“…В литературе встречаются всего несколько описаний ранений графитом, и только два из них в полости стекловидного тела [12,13]. При этом в некоторых примерах, даже несмотря на потенциальную инертность, пребывание ИТ в глазу сопровождалось стерильным эндофтальмит-подобным процессом, в том числе даже после длительного ареактивного периода [12][13][14][15][16][17][18][19][20][21]. Было высказано предположение, что причиной тяжелой воспалительной реакции у данных пациентов явились другие компоненты карандаша, такие как дерево или алюминий [13].…”

Management of penetrating injury with retained intraocular lead foreign body from a writing instrument: surgical video with implications for paediatric public health and safety

“…The main component of pencil is carbon which is thought to remain inert in the eye. There are few cases in the literature of intraocular penetrating injuries with a retained pencil lead intraocular foreign body (IOFB) 3–6. However, there have been reports of pencil lead causing severe inflammatory reaction and endophthalmitis 7.…”