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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 2  |  Issue : 2  |  Page : 478-479

Intraocular eyelash-associated ocular inflammation and hypotony following open globe injury


Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Date of Submission20-Jul-2021
Date of Acceptance13-Jan-2022
Date of Web Publication13-Apr-2022

Correspondence Address:
Nirupama Kasturi
Department of Ophthalmology, JIPMER, Puducherry - 605 006
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1910_21

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  Abstract 


A 5-year-old girl presented with penetrating ocular trauma associated with severe intraocular inflammation and hypotony persisting after globe repair. On re-exploration, intraocular eyelashes were found in the posterior chamber causing fibrosis and ciliary body traction. The child underwent membranectomy with anterior vitrectomy. Postoperatively, the inflammation subsided with steroids and cycloplegic therapy and vision improved to 6/24. This report describes a unique case of intraocular eyelashes that caused severe inflammation along with hypotony that were not found by routine slit-lamp examination but identified during membranectomy.

Keywords: Amblyopia, corneal edema, eyelashes, hyphema, iridocyclitis, vitreous hemorrhage


How to cite this article:
Kasturi N, Chavhan P, Natarajan K. Intraocular eyelash-associated ocular inflammation and hypotony following open globe injury. Indian J Ophthalmol Case Rep 2022;2:478-9

How to cite this URL:
Kasturi N, Chavhan P, Natarajan K. Intraocular eyelash-associated ocular inflammation and hypotony following open globe injury. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 May 18];2:478-9. Available from: https://www.ijoreports.in/text.asp?2022/2/2/478/342910



Intraocular eyelashes following penetrating injuries can cause severe inflammation and fibrosis. Their presence may be missed preoperatively if they have migrated to the posterior chamber.


  Case Report Top


A 5-year-old girl was brought to the ophthalmology clinic with a history of injury to the right eye with the sharp metal end of a spinning top toy while playing. The parents mentioned that the child was crying, and rubbing the eye following the injury. Her chief complaints were pain, inability to open the eye, and reduced vision in the injured eye. At the time of presentation, her visual acuity was perception of the light in the right eye and 20/20 in the left eye. She was uncooperative for the assessment of the projection of rays. On examination, there was lid edema and circumcorneal congestion in the right eye. Slit-lamp examination revealed a paracentral 4 mm linear corneal laceration from 2 to 5 o'clock, with iris incarceration and a full chambered hyphaema. The child underwent corneal tear repair with iris abscission. The anterior chamber was reformed, and the iris tissue was sent for the microbiological examination which showed no growth. Postoperatively, the anterior chambered clot contracted gradually. Ultrasound performed 3 days after the surgery revealed hyper-reflective echoes and membranes suggestive of vitreous hemorrhage [Figure 1]. The child was discharged with close follow-up on systemic and topical steroids along with 1% atropine eye ointment. Four weeks later, the child returned with an increase in redness and pain in the same eye. Slit-lamp examination revealed an occlusio pupillae, iris bombe, peripheral anterior synechiae from 2 to 6 o'clock, and at 10 o'clock. Intraocular pressure was 3.5 mmHg [Figure 2]. The child underwent synechiolysis with a reformation of the anterior chamber along with membranectomy under general anesthesia. Intraoperatively, four eyelashes were recovered from the posterior chamber behind the iris. Postoperatively, the inflammation subsided [Figure 3]. The best-corrected visual acuity improved to 6/24 and intraocular pressure increased to 10 mmHg at the end of 6 weeks. The child was given visual rehabilitation with aphakic contact lens and amblyopia treatment.
Figure 1: Slit-lamp image showing iris bombe with peripheral anterior synechiae and occlusio-pupillae

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Figure 2: Ultrasound B-scan image showing vitreous hemorrhage sans retinal or choroidal detachment

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Figure 3: Slit-lamp image showing reduced inflammation, formed anterior chamber, and aphakia

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  Discussion Top


Intraocular eyelashes constitute 0.4% of all intraocular foreign bodies following an open globe injury.[1] They are not commonly encountered as there is a delayed reflex closure of the eyelids, which prevents the contact of the inflicting object with the eyelid margin and eyelashes.[2] The eyelashes are also more likely to get epilated when a relatively blunt-tipped and slow-moving object strikes the eye. In our case, the lashes were epilated and dislodged intraocularly as the child continuously rubbed the eye following trauma.

Eyelashes have been recovered in the anterior chamber, posterior chamber, lens, vitreous, pars plana, or retina, and the eyes respond differently to their intraocular presence. Various reports have cited plastic iridocyclitis, endophthalmitis, granulomatous inflammation, corneal endothelial cell loss, intralenticular abscess, iris cyst formation, tractional retinal detachment, and even sympathetic ophthalmia as occurring in eyes with intraocular cilia associated with open globe injury.[2],[3],[4] There have been cases where the patients were asymptomatic, with eyelashes remaining dormant in the eye following intraocular migration after trauma or cataract surgery.[5],[6] It is plausible that intraocular eyelash in the cornea or anterior chamber may remain inert but when presented in the posterior chamber may invoke extensive iridocyclitis.

Pre-operative detection of the posterior chamber intraocular eyelashes is difficult because it is < 0.5 mm in thickness and cannot be imaged using an X-ray or the CT scan. It can be identified using ultrasound biomicroscopy or ultrasound B-scan when it is surrounded by a fibrous capsule, in which case it can give rise to echoes of high reflectivity with or without orbital shadowing.[7]

Ocular hypotony could be explained by the severe inflammation causing exaggerated uveoscleral outflow, ciliary shutdown, or tractional membranes on the ciliary processes. While mild hypotony is often transient and is of little consequence, a pressure below 4–6 mmHg can have deleterious effects on ocular function. It can lead to maculopathy, optic nerve edema, choroidal folds, and if sustained can lead to atrophy and sclerosis of the ciliary processes and subsequent phthisis.[8] In our patient, steroid and cycloplegic therapy along with the removal of the foreign bodies, epiciliary membranes, and anterioposterior traction helped to resolve the inflammation and moderately increase the intraocular pressure. To our knowledge, this is the first reported case of intraocular eyelashes embedded in the posterior chamber associated with severe hypotony.


  Conclusion Top


This rare case is a reminder that intraocular eyelashes in the posterior chamber should be considered given the history of eye rubbing, even when routine examinations are negative for intraocular foreign bodies, and especially for patients with unrelenting intraocular inflammation.

Declaration of patient consent

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

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Wang JW, Zhang XY, Wang J, Zhang H. Recurrent endophthalmitis caused by intraocular eyelashes. Int J Ophthalmol 2019;12:346-7.  Back to cited text no. 1
    
2.
Meshksar A, Azimi A. Intralenticular cilia following penetrating ocular trauma: A case report. Iran J Med Sci 2019;44:176-9.  Back to cited text no. 2
    
3.
Ramos GZ, Goncalves TB, Bordon AF. An unusual case of nine cilia embedded in the retina after a perforating ocular injury. Am J Ophthalmol Case Rep 2020;17:100587.  Back to cited text no. 3
    
4.
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. 4
    
5.
Jinagal J, Gupta PC, Ram J. Intraocular cilia. Indian J Ophthalmol 2018;66:1193.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Islam N, Dabbagh A. Inert intraocular eyelash foreign body following phacoemulsification cataract surgery. Acta Ophthalmol Scand 2006;84:432-4.  Back to cited text no. 6
    
7.
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. 7
[PUBMED]  [Full text]  
8.
de Smet MD, Gunning F, Feenstra R. The surgical management of chronic hypotony due to uveitis. Eye (Lond) 2005;19:60-4.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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