A healthy 59-year-old Caucasian man presented with complaints of an increasingly red eye and a pigmented lesion of a few weeks’ duration. He denied recent ocular trauma but did state that the same eye had an object removed from a similar location in the past.

On slit-lamp examination, the lesion was relatively immobile. Differential diagnoses included conjunctival melanoma and prolapsed uvea. Before surgical intervention, we performed ultrasound biomicroscopy. After noticing shadowing posterior to the lesion, we added retained foreign body to the differential diag­nosis, although the patient again denied eye trauma. B-scan demonstrated that the object was encased, with intact sclera deep to the lesion.

Removal of the object was completed under topical anesthesia through a 3-mm conjunctival incision, and pathology confirmed the suspected diagnosis of a retained foreign body.