A Ball of Cotton Wool Masquerading as a Conjunctiva Mass.

Sir,

We report an unusual form of ocular foreign body in a 3year – old girl who presented clinically with a right conjunctiva mass in the right eye of 3 weeks duration. There was associated recurrent discharge and occasional periorbital swelling. No previous trauma or surgery to the eye. Examination showed best corrected visual acuity of 6/6 in both eyes. There was a 10mm by 6mm mass in the lateral 3rd of the inferior fornix of the right eye. The rest of both eyes were normal. While attempting to excise the mass, it shelled out completely with minimal bleeding revealing a yellowish white fluffy material (Figure 1) which on polarized microscopy was cotton wool.

Figure 1

There have been several reports on retained wooden materials1 and sutures2 but not so much have been reported on retained cotton wool ball in the conjunctiva fornix. An excision biopsy was in line considering the appearance of the lesion which gave an initial clinical impression of a conjunctiva papilloma or a conjunctiva inclusion cyst. Inclusion cyst of the conjunctiva had been found in association with ocular surgery, inflammatory conditions or trauma.3 There had been a reported case resulting from chronic vernal conjunctivitis4 and retained hair.5

The source of the cotton wool in this case could not be ascertained. The possibility of an older sibling using cotton wool buds which are small wad of cotton wrapped around the end of short rod to clean the lids of a younger sibling cannot be overlooked. This case report helps to further reinforce the need for better parental attention to children handling of potential foreign bodies.