171: Chapter 171 Contact Lenses? Embedded in the Eyelid? For Over 25 Years?
1:30 PM.
The pace of admissions in the Red Zone was steady.
After Lu Chen finished with an acute cholecystitis referral, the internal line from the Green Zone rang again.
"Dr. Lu, we have a patient here with a rather special situation. Attending Physician Wang has already consulted with Attending Physician Zhao, and Attending Physician Zhao said it would be fine for you to come take a look."
"What's the situation?"
"A forty-two-year-old female with swelling and ptosis of the left eyelid. It's been like this for several weeks. She saw a doctor at an outside clinic, and they said it was a chronic chalazion and told her to apply warm compresses and observe it, but it never got better. She registered for the Emergency Department herself today."
"Isn't Ophthalmology seeing patients?"
"There's only one doctor on duty in Ophthalmology this afternoon, and the queue is going to be over three and a half hours long. The patient said the pain is unbearable and she can't wait. Attending Physician Wang did a preliminary check and said the texture of the lump is a bit strange—it doesn't look like a typical cyst. He wants you to use your, uh, precision examination method to help determine what it is."
Lu Chen knew what he was talking about.
Although people in the department didn't know about the existence of the Eye of Truth, they had all vaguely noticed a pattern: as long as it was a patient Lu Chen had seen, the diagnosis was never wrong.
Therefore, whenever they encountered a case they weren't sure about, their first reaction was to call Lu Chen over.
"Alright, I'm coming over."
Lu Chen stood up, gave some instructions to Meng Yan, and then walked toward the Green Zone.
When he arrived at the entrance of the Green Zone clinic, Attending Physician Wang was already waiting for him.
"Dr. Lu, come take a look at this patient. I keep feeling like something isn't right."
"What's wrong with it?"
Attending Physician Wang was an internist in his early forties, experienced but relatively conservative.
"She says her left eyelid has been swollen for three weeks. At first, I also thought it was a chalazion, but I just flipped her upper eyelid to take a look, and the texture of the lump is extremely hard. There is a distinct sensation of a foreign object when pressed. It doesn't feel like it was formed by a blockage of glandular secretions; it feels more like there's something inside."
"Something like what?"
"I don't know. It feels like a thin, hard object, but I can't say for sure what it is."
Lu Chen walked into the clinic.
A woman around forty-two years old was sitting on the examination chair.
Her left eye was clearly asymmetrical to her right.
The left upper eyelid was swollen and drooping, covering about one-third of the iris, and the whole eyelid looked heavy.
There was no obvious redness or heat on the surface of the skin, which didn't look like an acute inflammation.
But the shape of the eyelid was indeed abnormal.
"Hello, I am Dr. Lu from the Emergency Department. Would it be alright if I take a look?"
"Yes, doctor, thank you for your trouble."
The woman's tone carried anxiety.
"My eyelid has been swollen for almost a month, and it's getting heavier. At the beginning, I just felt that my left eye was a bit uncomfortable. When I looked at things, I always felt like something was scratching my eye. Later, the eyelid started to droop little by little."
"Have you seen anyone about it elsewhere?"
"Yes, the doctor at the community clinic said it was a chalazion and told me to apply warm compresses. I applied them for three weeks, but it didn't get any better."
"Have you had any examinations done?"
"No, that doctor said there was no need for examinations, just warm compresses would do."
Lu Chen nodded.
"Let me examine it first."
He first used his fingers to gently perform Palpation on the swollen area of the left upper eyelid.
The sensation at his fingertips was very clear.
Deep in the eyelid tissue, there was a hard foreign object, about one centimeter square.
The surface was smooth but the edges were slightly irregular, firmly wrapped by the surrounding hyperplastic fibrous tissue.
This sensation was wrong.
A chalazion is formed by the blockage of glandular secretions; the texture should be semi-solid, with a certain degree of elasticity and fluctuation.
But the texture of this thing was hard, and it was too thin.
It was like some object wrapped in tissue.
Lu Chen activated the Eye of Truth.
[Eye of Truth scan complete]
[Patient Information: Female, 42 years old]
[Chief Complaint: Progressive swelling and ptosis of the left upper eyelid for over 1 month]
[Eye of Truth Diagnosis: A foreign object is embedded in the deep subconjunctival tissue of the left upper eyelid. The foreign object is a fragment of a rigid gas-permeable contact lens made of polymer material, approximately 10mm x 8mm in size. A fibrous capsule wall about 3mm thick has formed around the foreign object, and the local conjunctival tissue shows chronic inflammatory hyperplasia. The foreign object has been embedded for an extremely long time, estimated to be over 25 years.]
[Danger Level: D]
[Current Symptoms: Left upper eyelid swelling, mechanical ptosis, intermittent foreign body sensation, recurrent chronic conjunctivitis]
[Recommendation: Perform eyelid conjunctival incision and foreign body removal under local anesthesia. The procedure is simple, but care must be taken regarding the degree of adhesion between the foreign object and the surrounding tissue to avoid damaging the levator palpebrae superioris aponeurosis and orbital septum structures.]
[Warning: The foreign object has been embedded for too long, and the fibrous capsule layer is dense. Careful separation is required during removal to avoid leaving fragments behind.]
Lu Chen stopped for two seconds after reading the diagnostic information.
A contact lens.
Embedded inside the eyelid.
Over 25 years.
He withdrew the Eye of Truth and looked at the patient.
"Have you ever worn contact lenses before?"
The woman was stunned for a moment.
"Contact lenses?"
"Yes, the hard kind."
The woman thought for a while.
"I wore them a long time ago. I practiced badminton for a few years when I was a teenager."
"At that time, I felt that wearing glasses was inconvenient for playing, so my mother got me a pair of hard contact lenses."
Lu Chen's expression didn't change, but he already had a judgment in his heart.
"How long did you wear them?"
"Not long, maybe for about half a year. Later, when I was playing, I was hit in the eye by a racket, and the contact lens disappeared. At the time, I thought it had been knocked out and fell on the ground. I looked for it for a long time but couldn't find it, so I didn't wear them anymore."
"How old were you then?"
"Fourteen."
Fourteen.
She is forty-two now.
Twenty-eight years.
Lu Chen confirmed the diagnosis of the Eye of Truth in his heart.
This contact lens fragment had slid from the surface of the cornea into the depths of the superior conjunctival fornix due to the impact of the external force twenty-eight years ago.
Then it moved upward and embedded itself into the subconjunctival tissue of the upper eyelid.
After that, the human body's fibrous hyperplasia response formed a thick capsule wall around the foreign object, completely sealing the contact lens inside.
For twenty-eight years, this contact lens had been quietly staying deep in her eyelid.
Until recently, perhaps because of the decrease in the elasticity of the eyelid tissue due to aging, or because the inflammation of the capsule wall worsened, causing swelling.
The presence of the contact lens became more and more obvious.
This case was indeed rare.
But it was not unrecorded in medical literature.
Lu Chen looked at Attending Physician Wang.
"Attending Physician Wang, the hard object you felt just now should be a contact lens."
Attending Physician Wang's eyes widened suddenly.
"What?"
"A contact lens, the hard kind, embedded in the subconjunctival layer of her upper eyelid, completely wrapped by fibrous tissue."
Attending Physician Wang opened his mouth.
"Are you sure?"
"I'm sure. The contact lens she lost when she was playing badminton at fourteen didn't fall out; it slid into the depths of the superior conjunctival fornix, and then was wrapped by body tissue. It's been twenty-eight years."
The whole clinic was quiet for two seconds.
The patient's expression froze.
"What do you mean? You're saying there's a contact lens in my eyelid?"
"Yes."
"It's been inside for twenty-eight years?"
"Yes."
"How is that possible?"
Her voice carried disbelief.
"The contact lens I lost when I was fourteen has been in my eyelid all this time?"
"Hard contact lenses made of polymer materials do not degrade in human tissue. The body treats it as a foreign object and uses fibrous tissue to wrap it up, forming a capsule wall, and it just stays inside like that."
"Have you had any unexplained inflammation or foreign body sensation in your eye repeatedly over the past twenty-eight years?"
The woman recalled, and the expression on her face became complicated.
"Yes, it's been like that since I was young. My left eye was always red and itchy for no reason."
"I've seen Ophthalmology many times, and they all said it was chronic conjunctivitis. They prescribed eye drops and sent me back. No one ever said there was anything inside."
Lu Chen said helplessly.
"Because it was buried too deep, routine slit-lamp examinations cannot see foreign objects in the subconjunctival layer."
"Especially after being completely wrapped by the fibrous capsule wall, it just looks like a lump of unknown nature when observed from the outside."