A red and watering eye

A woman in her 60s reported a one day history of redness, foreign body sensation, and watering in the right eye. She could not recall any event or trauma to the eye but said she had been gardening recently. She was taking medications for hypothyroidism and hypertension, which were well controlled. On examination her visual acuity with glasses was 20/30 in both eyes and there was redness in her right eye. Slit lamp examination of the right eye showed multiple linear corneal epithelial abrasions which were more visible after the cornea was stained with sodium fluorescein (fig 1, left). Slit lamp examination after eversion of the upper eyelid revealed a foreign body embedded in the upper palpebral conjunctiva (fig 2, arrow, captured with a fundus camera). Cataracts were noted in both eyes. The fundus camera in the fluorescein angiography mode captured the abrasions after the topical fluorescein stain (fig 1, right).1