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Purpose: To report a case of retained anterior chamber graphite foreign body with subsequent inflammation 20 years later. Observations: A 29-year-old female who presented with first episode of acute blurring of vision and eye redness was noted to have a retained intraocular graphite foreign body in her anterior chamber. She recalled being accidently hit by a mechanical pencil 20 years ago. Conclusions and importance: Retained intraocular graphite foreign bodies are inert and generally do not cause inflammation. This is the longest reported duration of retained anterior chamber graphite foreign body that developed subsequent inflammation and corneal endothelial damage only 20 years later.