Phlyctenulosis-Like Presentation Secondary to Embedded Corneal Foreign Body

Case Presentation: A nine-year-old boy presented to the general ophthalmologist with a several weeks history of redness, photophobia and intermittent foreign body sensation in the right eye. A pigmented lesion with anterior chamber inflammation was noted on examination. B-scan ultrasound was performed and revealed no foreign body. The patient was diagnosed with anterior uveitis, which did not completely respond to treatment. The differential diagnosis was expanded to include peripheral ulcerative keratitis, phlyctenulosis, pigmented neoplasm, and corneal foreign body. Upon referral to a cornea specialist, an exam under anesthesia revealed a large foreign body consistent with a rock fragment in the peripheral cornea, which was subsequently removed without complication. Conclusion: This case highlights an atypical presentation of foreign body as well as a differential diagnosis of pigmented peripheral corneal lesions. Foreign bodies represent the most common cause of urgent ophthalmic evaluation. When evaluating lesions of the cornea, it is imperative to keep an extensive differential diagnosis, giving the potential for severe and rapid development of visually threatening complications.