Photo Quiz: A 45-Year-Old Man with Acute Unilateral Eye Pain

A  45-year-old immunocompetent man presented at the emergency unit of the Sainte-Anne hospital in Toulon (south of France) after 3 h of left-eye pain. He did not describe ocular discharge. He had no specific medical or travel history. He experienced sudden ocular pain with foreign-body sensation while moving out the garbage. The clinical examination showed a red and painful eye without photophobia. Ophthalmologic examination with a slit lamp revealed four foreign bodies, 1 mm long, fleeing light and moving on the lower palpebral conjunctiva to the fornix. Hyperhemia was observed on the bulbar and palpebral conjunctiva. Fluorescein examination did not indicate corneal keratitis. The anterior chamber showed no deposit or hemorrhage, and iris was normal. After local application of oxybuprovacaine, 4 foreign bodies were removed by physiological saline irrigation and sent to the microbiology laboratory for identification. The obtained elements had a pearly white aspect and were motile. Microscopic examination revealed that these elements were covered with spines (Fig. 1A) and possessed hooks and spines in the extremities (Fig. 1B and C).

FIG 1.

(A) Element presenting rows of spines pointed by arrow (×100 total magnification). (B) Anterior extremity with two curved large hooks (×400 total magnification). (C) Posterior extremity with about 20 small spines arranged in two groups (×400 total magnification).