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Wooden foreign body in upper punctum: a commonly overlooked uncommon entity

Foreign bodies in the lacrimal drainage system are a rare cause of chronic ocular discomfort and may remain unrecognised unless looked for with high suspicion. As optometrists may be the first contact between patients and medical eye health care in developing countries like India, these foreign bodies can also be managed by optometrists and their timely removal can prevent resultant grave complications and unnecessary referral to higher medical centres. A 32-year-old male presented with localised irritation and redness on the nasal side of the right eye for seven days. Visual acuity was 6/6 in both eyes. Slitlamp examination showed localised congestion and chemosis of nasal conjunctiva and a bifurcating brown mass entangled in mucoid debris (suggestive of wooden foreign body) protruding from the upper punctal orifice in the right eye (Figures 1 and 2). After obtaining written informed consent, the foreign body was removed under direct slitlamp visualisation using non-traumatic forceps. Examination of the foreign body revealed a bifurcated bulbous end on one side and a sharp, tapering end on the other side (Figure 3). A course of topical antibiotic-steroid combination and preservative-free lubricants were prescribed with complete resolution of signs and symptoms by the end of three days. Various other types of organic and inorganic foreign bodies encountered in the upper punctum include scalp hair,