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 Table of Contents    
CLINICAL IMAGE
Year : 2022  |  Volume : 15  |  Issue : 3  |  Page : 421-422  

Incidental rare intraocular foreign body discovered after penetrating injury 30 years ago


Department of Ophthalmology, Great Western Hospital, Swindon, England

Date of Submission09-Aug-2021
Date of Decision31-Mar-2022
Date of Acceptance31-Mar-2022
Date of Web Publication02-Nov-2022

Correspondence Address:
Shamus Butt
Department of Ophthalmology, Great Western Hospital, Swindon
England
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ojo.ojo_237_21

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   Abstract 


Keywords: Eye injury, eyelash, vitreo-retinal interface, vitreous


How to cite this article:
Butt S, El-Ashry M. Incidental rare intraocular foreign body discovered after penetrating injury 30 years ago. Oman J Ophthalmol 2022;15:421-2

How to cite this URL:
Butt S, El-Ashry M. Incidental rare intraocular foreign body discovered after penetrating injury 30 years ago. Oman J Ophthalmol [serial online] 2022 [cited 2022 Dec 2];15:421-2. Available from: https://www.ojoonline.org/text.asp?2022/15/3/421/360402



Intraocular cilia are rarely associated with penetrating eye injuries. There remains a paucity of data on the presence and impact of intravitreal cilia on orbital physiology. We describe a case of a rare intraocular foreign body associated with penetrating eye trauma over 30 years ago.

A 60-year-old gentleman presented with the right eye (RE) reduced visual acuity (VA) and intolerance to glasses/visual correction in June 2017. He denied pain, photophobia, or other visual disturbance. The patient recounted a small penetrating injury involving a nail hitting his RE 30 years ago. On examination, early nuclear sclerosis was noted in the RE and fundoscopy revealed large optic discs (0.8 CD ratio each) but normal pressures. Best-corrected VA (BCVA) was 0.12 RE and 0.02 left eye (LE) (Logmar) and spherical equivalents were −2.6D in the RE and +0.6D in the LE.

Repeated examination in June 2019 revealed an incidental finding of a suspected graphite foreign body in the RE inferotemporal quadrant with associated retinal scarring [Figure 1]a. The RE nuclear sclerosis had progressed with further drop in VA (BCVA Logmar 0.44 RE, 0.08 LE). B-scan, computed tomography, and magnetic resonance imaging identified no obvious intraocular foreign bodies [Figure 1b],[Figure 1]c,[Figure 1]d.
Figure 1: Dilated fundoscopy demonstrated a suspected graphite foreign body in the RE inferotemporal quadrant with associated scarring (a). B-scan (b), CT (c), and MRI (d) demonstrated no abnormalities. RE: Right eye, CT: Computed tomography, MRI: Magnetic resonance imaging

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Under general anesthesia, the patient underwent RE phacoemulsification with intraocular lens insertion, pars plana vitrectomy, removal of intraocular foreign body (eyelash), endolaser retinopexy, and internal tamponade using C3F8 gas and settled well postoperatively. The patient was discharged with a standard course of maxidex 0.1%, cyclopentolate 1%, and chloramphenicol 0.5%. At 6-week follow-up, the patient was stable with improved VA (BCVA Logmar 0.22 RE, 0.00 LE).


   Discussion Top


Organic intraocular foreign bodies within the vitreous cavity are rare findings, with an incidence up to 1/187,000.[1] As such, there is limited evidence discussing the impact of intraocular cilia on eye health.

Intraocular eyelashes are associated with variable presentations, from asymptomatic to endophthalmitis and retinal detachment.[2],[3] Intraocular cilia have been retained for as little as 6 weeks to beyond 40 years ago.[3],[4] Management approaches vary depending on the clinician and patient presentation, from a watch-and-wait stance to intervention to expel the eyelash.[1],[5]

To our knowledge, the literature contains substantially limited cases of intravitreal cilia. One notable case denotes a 70 years old presenting with sudden visual loss and floaters in the RE, with a history of penetrating eye trauma from a “sharp object” 40 years ago. Examination demonstrated rhegmatogenous retinal detachment with no inflammation.[3] However, no conclusion could be drawn as to whether the intraocular eyelash was the primary cause of significant retinal disruption.

This patient's cataract presentation incidentally revealed a suspected retained eyelash within the vitreous cavity from penetrating eye trauma over 30 years ago, with unexplained mechanism of cilium insertion. Our patient demonstrated no significant inflammatory signs and the eyelash appeared remarkably unchanged and intact. This suggests a high level of tolerance of cilia matter within the posterior segment. Most notably, the eyelash remained undetected despite the wide array of imaging modalities used. This highlights the need to maintain a high level of clinical suspicion following ocular injury.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Acknowledgments

Special thanks to Dr. Panayiotis Maghsoudlou for his significant guidance on writing this unique case.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Gopal L, Banker AS, Sharma T, Parikh S, Bhende PS, Chopra S. Intraocular cilia associated with perforating injury. Indian J Ophthalmol 2000;48:33-6.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Sahu S, Puri LR, Singh SK. Intraocular eyelashes and iris cyst in anterior chamber following penetrating eye injury: A case report. Int Med Case Rep J 2017;10:105-7.  Back to cited text no. 2
    
3.
Dettoraki M, Andreanos K, Davou S, Nomikarios N, Moschos MM, Brouzas D. Intravitreal cilium associated with retinal detachment 40 years following penetrating eye injury: A case report. BMC Ophthalmol 2015;15:25.  Back to cited text no. 3
    
4.
Humayun M, de la Cruz Z, Maguire A, Dangel ME, Stark WJ, Green WR. Intraocular cilia. Report of six cases of 6 weeks' to 32 years' duration. Arch Ophthalmol 1993;111:1396-401.  Back to cited text no. 4
    
5.
Olorenshaw GM, Brooks AM, Grant G, Gillies WE. Tolerance of the eye for implanted cilia. Br J Ophthalmol 1991;75:622-3..  Back to cited text no. 5
    


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