organic foreign bodies are generally associated with severe inflammatory reaction and infection , while the nature of reaction elicited by inorganic foreign bodies depends on the material of the foreign body .
graphite , which is the major constituent of pencil lead , has been reported to remain inert in the eye for a long time .
however , it has also been reported to cause severe endophthalmitis - like reaction in the eye .
we report a rare case of retained graphite pencil tip in the anterior chamber of a six - year - old girl .
a six - year - old girl presented to us with history of mild pain in the left eye of two days duration .
the child s mother gave a history of trauma with a graphite lead pencil about four months ago at school when she was accidentally poked in the left eye by another child .
the child had not been examined by an ophthalmologist after the incident as she was apparently asymptomatic at the time . on examination ,
the best corrected visual acuity was 20/20 in the right eye and 20/40 in the left eye .
there was a full thickness corneal scar ( figure 1 ) in the left eye .
a small area of iris atrophy with a sphincter tear was noted at the edge of the pupil at the 6 o clock position . there was a black foreign body resembling a graphite pencil lead tip , measuring about 1.5 mm in size , on the iris at the 7 o clock position ( figure 1 ) .
ocular ultrasonography of the left eye did not reveal any abnormality in the posterior segment .
figure 1slit lamp photograph of the left eye showing the corneal scar and the graphite pencil lead tip on the iris . 
 
slit lamp photograph of the left eye showing the corneal scar and the graphite pencil lead tip on the iris .
a corneal incision was made at 5 o clock position with a 2.8 mm keratome .
the anterior chamber was filled with 2% methyl cellulose and the foreign body ( figure 2 ) was removed in toto with a bechert - mcpherson forceps .
the remaining graphite particles were aspirated out with a simcoe cortex aspiration cannula using an anterior chamber maintainer .
post - operatively , the patient was put on tapering doses of topical steroids and cycloplegics . on
follow up , one month later , the best corrected visual acuity in the left eye was 20/40 .
there was no inflammation ; the lens was clear and the fundus was normal . 

the reaction of the eye to a retained intraocular foreign body varies depending on its composition .
foreign bodies comprised of materials like gold , silver and platinum have been reported to remain inert in the intraocular environment .
there are only a few reports of ocular trauma with retention of graphite pencil lead in the eye .
retained graphite has been described in the conjunctiva , cornea , angle of the anterior chamber and the posterior segment . a case of pencil - tip injury to the orbit with retained graphite foreign body associated with delayed orbital infection has also been described .
however , the potential toxicity of the other constituents of pencil lead like animal fats and clay is not clearly known .
there has been a report of severe endophthalmitis - like reaction incited by retained graphite foreign bodies in the vitreous . in this case , it is unclear whether the reaction was induced by the other constituents of pencil lead like the aluminium in the kaolinite or if there was an associated infection . in our case
, we decided to surgically remove the intraocular foreign body in spite of the fact that it had obviously remained in the eye for some time ( as evidenced by the healed corneal scar and presence of iris atrophy ) without inciting an inflammatory response or causing much damage to the intraocular structures .
there was a distinct possibility of causing damage to the lens and inciting an inflammatory reaction during surgical removal of the foreign body .
this risk had to be weighed against that of the damage the foreign body might cause if it was left in the eye .
there was a chance that the foreign body would get dislodged into the angle at a later stage and cause progressive damage to the angle structures and the cornea as in the case reported by han et al .
honda et al . have reported a case of a five - year - old child with a graphite foreign body lodged in the peripheral retina , whom they followed up for six years with serial electroretinograms , fundus photographs and fundus fluorescein angiography .
there was no evidence of any damage to the eye caused by the foreign body at the end of their follow up .
however , in our case , such meticulous follow - up would have been quite impossible as the child s family belonged to a poor socio - economic background and the parents would not have been able to afford the cost of repeated hospital visits and investigations .
our case also differed from honda et al.s case in that the foreign body was in the anterior segment and therefore , was at a more accessible site .
there was a higher chance of removal of the foreign body without causing damage to the intraocular structures in our case . in conclusion
, graphite foreign bodies may be retained in the eye without causing any inflammation or damage to the intraocular structures . on the other hand , there is also the possibility of progressive damage to intraocular structures by these foreign bodies due to various mechanisms .
therefore , the decision about surgical removal of the foreign body has to be made on an individual basis after taking multiple factors into consideration and estimating the risk - benefit ratio in each patient .
 retained intraocular graphite foreign bodies are uncommon . 
 although they are generally inert , they have been reported to cause severe inflammatory reaction and progressive damage to intraocular structures . 
 we report a case of a six - year - old girl with a retained intraocular graphite pencil lead foreign body in the anterior chamber of the eye and discuss the various considerations in the management of such cases . 
Introduction
Case Report
Discussion