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 1a]. 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-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
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
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.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Acknowledgments
Special thanks to Dr. Panayiotis Maghsoudlou for his significant guidance on writing this unique case.
References
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