A case report of retained intracameral eyelash following trauma

Hage Amung; Parul Jain; Isha Gupta; Arun Mehta

doi:10.4103/IJO.IJO_380_23

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CASE REPORT

Year : 2023 | Volume : 3 | Issue : 2 | Page : 306-307

A case report of retained intracameral eyelash following trauma

Hage Amung, Parul Jain, Isha Gupta, Arun Mehta
Department of Ophthalmology, Guru Nanak Eye Center, Maulana Azad Medical College, New Delhi, India

Date of Submission	06-Feb-2023
Date of Acceptance	24-Feb-2023
Date of Web Publication	28-Apr-2023

Correspondence Address:
Hage Amung
J192, Anand Bhawan, B Wing Third Floor, Arjun Nagar, Safdurjung Enclave, New Delhi - 110 029
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJO.IJO_380_23

Abstract

Intraocular cilium is a very rare intraocular foreign body. We report a 24-year-old male patient who presented with self-sealed corneal laceration with retained eyelash in the anterior chamber, following an injury with a plastic object. In view of the anterior chamber reaction, topical and oral steroids were started and surgical removal of the intraocular eyelash was performed.

Keywords: Foreign body, intraocular eyelash, penetrating injury

How to cite this article:
Amung H, Jain P, Gupta I, Mehta A. A case report of retained intracameral eyelash following trauma. Indian J Ophthalmol Case Rep 2023;3:306-7

How to cite this URL:
Amung H, Jain P, Gupta I, Mehta A. A case report of retained intracameral eyelash following trauma. Indian J Ophthalmol Case Rep [serial online] 2023 [cited 2023 Jun 10];3:306-7. Available from: https://www.ijoreports.in/text.asp?2023/3/2/306/375048

The presence of intraocular cilia (eyelash) following penetrating injury or surgical intervention is rare.^[1] Intraocular cilia have been found in the anterior^[2],[3] and posterior chambers, embedded in the iris, within the vitreous cavity^[4] and the lens.^[5],[6] The cilium may remain inert in the eye for a long period without eliciting any response but decreased visual acuity, foreign body sensation, iridocyclitis, acute inflammatory reaction, granulomatous inflammation, cyst formation, corneal decompensation, vitreous fibrosis, bacterial endophthalmitis, and even sympathetic ophthalmia have been attributed to intraocular cilia following trauma or surgery.^[7]

Case Report

A 24-year-old male patient presented to the Ophthalmology OPD complaining of sudden diminution of vision in the right eye following trauma 8 days back with a plastic object. He had complaints of pain, redness, and photophobia. He had no systemic comorbidities.

On examination, vision in the right eye was finger count at three meters with accurate projection of rays in all quadrants.

Slit lamp examination showed conjunctival congestion with self-sealed corneal laceration (1 mm × 2 mm) at 10–11 o clock position, with cells 4+ in the anterior chamber. An eyelash was in the anterior chamber, adherent to the anterior lens capsule. Seidel's and forced seidel's tests were negative. Digital tension was normal. On indirect ophthalmoscopy for fundus examination, the media was hazy. Extraocular movements were full and free.

USG Bscan showed vitreous with no evidence of a foreign body. X-ray orbit was within normal limits. The representative images of the eye are shown in [Figure 1]a, [Figure 1]b, [Figure 1]c, [Figure 1]d.

Figure 1: (a) Slit lamp image of the right eye showing leucomatous corneal opacity with intracameral eyelash. (b) Slit lamp image of the right eye at 2-week follow-up showing hypopyon. (c) ASOCT of the right eye showing hyperreflective dot over the lens with backshadowing. (d) Intra-op image of the right eye showing intracameral eyelash

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The patient was managed with tablet Wysolone 40 mg od, eyedrops lotesol qid, moxifloxacin qid, tobramycin qid, carboxymethylcellulose qid, and ointment atropine tds.

At 2-week follow-up, the vision had improved to 6/12 on the Snellen chart, the anterior chamber reaction had decreased, inflammatory hypopyon was present, and there were pigments on the anterior lens capsule. Fundus examination was within normal limits. The oral steroid was tapered.

In 4^th week, there was vascularized adherent leucomatous opacity at the site of the sealed corneal laceration, with posterior synechiae. The anterior chamber had 2+ cells. Hypopyon had resolved. Surgical removal of intracameral hair was performed in view of the anterior chamber reaction, and to avoid complications of recurrent anterior chamber reactions, granulomatous inflammation, cyst formation in the anterior chamber, corneal decompensation, and iridocyclitis.^[7],[8] Under local anesthesia, straightforward corneal entry with a side-port blade was made at 6 and 12 o'clock positions, and the anterior chamber was filled with an ophthalmic viscosurgical device. The cilia were gently manipulated with a 25-gauge hydrodissection cannula and removed with vitreoretinal forceps. A subconjunctival antibiotic (gentamycin 0.4 ml) with steroid (injection dexamethasone 0.4 ml) was given. On the first postoperative day, the patient had anterior chamber cells 1+ and was treated with topical steroids (1% prednisolone acetate eye drops 2 hourly), antibiotic (0.3% tobramycin eye drops qid), and systemic steroids (tapering dose). By 1 week, the inflammation subsided with occasional cells in the anterior chamber. Topical medications were tapered. The best corrected visual acuity was 6/6 on the Snellen chart with −0.5 diopters cylinder at 42 degrees axis.

Discussion

Intraocular cilia following penetrating injury are extremely rare. In one series, intraocular cilia formed 0.4% of all intraocular foreign bodies.^[7] An explanation has been given by Duke Elder^[1] for this low incidence that in case of a penetrating injury, the eyelids are expected to close by reflex only after the foreign body contacts the conjunctiva or cornea. So, the eyelashes usually do not come in the path of the foreign body. Post-traumatic intraocular cilia comprise a small portion (0.4%) of all intraocular foreign bodies.^[9] Anterior chamber cilia account for 45% of all intraocular cilia.^[9] If no inflammation is present, the patient may be kept under observation. Nevertheless, surgical removal is necessary, if inflammation or infection becomes apparent during the observation period.

In the literature, there is a report of silent cilia existing in the anterior chamber for 50 years.^[10] The decision to remove an intraocular eyelash remains a matter of controversy but should become a definite indication at the onset of clinical signs of inflammation or infection. Some ophthalmologists prefer surgical intervention for the removal even in quiescent eyes to eliminate the potential risk of endophthalmitis.

Conclusion

The response of the eye to cilia is unpredictable ranging from a lack of reaction to severe intraocular inflammation. Surgical intervention for the removal of cilia is imperative in case of non-resolving inflammation and infection.

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

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