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Penetrating ocular trauma from a pencil lead

A five-year-old boy suffered from a penetrating left eye injury from a graphite pencil while playing at home. He presented with severe pain and loss of vision. The best corrected visual acuity was 6/6 in his right and 5/60 in his left eye. Anterior segment examination revealed blepharospasm, lid edema, conjunctival congestion, small graphite pencil with a wooden fragment embedded in the anterior chamber with an entry wound in the cornea, anterior chamber moderate depth with Seidel’s test positive (Figures 1 to 3). With a guarded visual prognosis, the patient was advised to undergo removal of the intraocular pencil with suturing of the corneal tear under general anesthesia (Figures 4 and 5). Consequently, there is less chance of injury to the eye itself. The child developed a post-traumatic focal cataract but as the central visual axis was clear he was able to read 6/6. Ocular injuries with graphite pencil lead are very rare. Graphite pencils are made of graphite and clay, mixed with animal oils and fats, with a wooden surround. Although graphite pencils are frequently used in classrooms and homes by young children, there is little literature on injuries to the eye and adnexa with these pencils. The commonly injured sites are the eyelids and orbit, probably due to the fact that when an Aravind Eye Hospital, Pondicherry, India Cornea and Refractive Services, Aravind Eye Hospital, Pondicherry, India