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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 56  |  Issue : 4  |  Page : 266-267

Intraocular cilia – A rare case report


Regional Institute of Ophthalmology and Government Ophthalmic Hospital, Madras Medical College, Chennai, Tamil Nadu, India

Date of Web Publication19-Feb-2019

Correspondence Address:
Dr. Malarvizhi Raman
Regional Institute of Ophthalmology and Government Ophthalmic Hospital, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_98_18

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  Abstract 


Intraocular cilium is a very rare intraocular foreign body. We report a middle-aged female patient who presented with a cilium in the anterior chamber of the right eye with iritis, following an injury with a stick. In view of anterior chamber reaction, the eyelash was removed. Postoperatively, the iritis resolved in 2 weeks with periocular and topical steroids.

Keywords: Cilia, injury, intraocular foreign body


How to cite this article:
Raman M, Anuradha A, Vasumathi K, Sheela S, Subbiah GN. Intraocular cilia – A rare case report. TNOA J Ophthalmic Sci Res 2018;56:266-7

How to cite this URL:
Raman M, Anuradha A, Vasumathi K, Sheela S, Subbiah GN. Intraocular cilia – A rare case report. TNOA J Ophthalmic Sci Res [serial online] 2018 [cited 2019 May 23];56:266-7. Available from: http://www.tnoajosr.com/text.asp?2018/56/4/266/252505




  Introduction Top


The presence of intraocular cilia (eyelash) following penetrating injury or surgical intervention is rare.[1],[2] It was first reported by Lerche in 1835. Intraocular cilia have been found in the anterior[3],[4] and posterior chambers, embedded in the iris, within the vitreous cavity[5] and the lens.[6],[7] So far, there has been only one case report of the cilia embedded in the retina.[8] The fate of the eyelash and the reaction of the eye to the same vary. The cilium may remain inert in the eye for a long period without eliciting any response. On the other hand, acute inflammatory reaction and even sympathetic ophthalmia have been attributed to intraocular cilia.


  Case Report Top


A 50-year-old female presented with complaints of redness, pain, watering, and photophobia in the right eye for 5 days.[9] She gave a history of injury to the right eye with a stick 5 days ago. On examination of the right eye, circumciliary congestion, with a self-sealed corneal wound of 1 mm × 1 mm, seen at 2–3 o'clock position. Iritis with cells 2+ and flare 2+ was also noted. An eyelash was found in the anterior chamber superiorly with bulbous end stuck onto the anterior capsule of the lens and pointed end on the iris between 12 and 1 o'clock position [Figure 1]. The lens was cataractous with Grade 2 nuclear sclerosis with posterior subcapsular cataract. Visual acuity was 3/60. Fundus examination was hazy due to lens changes, but otherwise normal. B scan was normal. As the patient had iritis, the removal of intraocular cilia was planned under cover of steroids.
Figure 1: Slit-lamp picture showing the intraocular cilia in the anterior chamber

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Under local anesthesia, clear corneal entry with a side-port blade was made at 12 o'clock position and the cilia were gently manipulated [Video 1] with 25-gauge hydrodissection cannula and removed with McPherson angled forceps. The cilia were examined and confirmed by histopathological examination under a microscope [Figure 2]. Intracameral antibiotic (0.5% moxifloxacin 0.4 ml) with subconjunctival steroid (injection dexamethasone 0.4 ml) was given. On the 1st postoperative day, the patient had iritis with cells 4+, flare 4+, and fibrinous reaction. The patient was treated with topical steroids (1% prednisolone acetate eye drops hourly), antibiotic (0.5% moxifloxacin eye drops two hourly), cycloplegic (1% cyclopentolate eye drops twice daily), and systemic steroids (tablet prednisolone 40 mg OD). By 1 week, the inflammation subsided with occasional cells and flare 1 + in the anterior chamber. Topical medications were tapered. Visual acuity was 3/60, and the patient was advised to continue topical medications with tapering of oral steroids. The patient was advised cataract surgery later.
Figure 2: Microscopic examination of the intraocular cilia under high magnification

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  Discussion Top


Intraocular cilia following penetrating injury are extremely rare. In one series, intraocular cilia formed 0.4% of all intraocular foreign bodies. These formed 0.4% of all intraocular foreign bodies seen in that series. An explanation has been offered by Duke Elder[1] for this low incidence. In case of penetrating injury, the eyelids are expected to close by reflex only after the foreign body contacts the conjunctiva or cornea, by which time it has cleared the lid margin. Hence, the eyelashes usually do not come in the path of the foreign body.

Duke Elder (1954) has stated the following types of possible reactions following an injury with cilia in the eye may occur:

  1. If contaminated by infection, an acute pyogenic inflammation may be set up[7]
  2. It may remain inert without exciting any reaction and may be discovered accidentally
  3. A delayed inflammation may sometimes develop even after many years which may be so destructive as to end in blindness
  4. Plastic iridocyclitis may occur
  5. It may excite a granulomatous reaction
  6. As a rarity, even sympathetic ophthalmitis may occur
  7. Cyst formation may occur as a typical delayed complication of a retention of an eyelash in the anterior chamber
  8. When the eyelash is present in the eye for a very long time, it may undergo structural changes such as depigmentation, splitting, and, in rare cases, may getabsorbed.


The innocuous nature of intraocular eyelash may be due to its inert nature and the immune privileged nature of the eye. When no inflammation is present, the patient may be kept under observation. Nevertheless, surgical removal is imperative, if inflammation or infection[7] becomes apparent during the observation period. Some ophthalmologists exercise surgical intervention for the removal even in quiescent eyes to obviate the risk of endophthalmitis.

Hence, when the surgical removal appears to be easy, no delay should be exercised in removing it, but if it is located at a place where removal is difficult, the risks should be weighed against the adoption of a policy of inactivity.[1] The decision to remove an intraocular eyelash remains a matter of controversy and should become a definite indication at the onset of clinical signs of inflammation or infection.

Declaration of the 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 names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Duke Elder S. System of Ophthalmology. Vol. 14. St. Louis, Mo.: C.V. Mosby Co.; 1972. p. 553-61.  Back to cited text no. 1
    
2.
Metrikin DC, Fante RG, Hodes BL. Intraocular cilia after penetrating eye injury. Arch Ophthalmol 1992;110:921.  Back to cited text no. 2
    
3.
Taneja S, Arora R, Yadava U. Fingernail trauma causing corneal laceration and intraocular cilia. Arch Ophthalmol 1998;116:530-1.  Back to cited text no. 3
    
4.
Srivastava US, Tyagi RN, Jain AK, Garg SK. Eye lashes in the anterior chamber of eye. Indian J Ophthalmol 1982;30:107-8.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
O'Brien CS. Cilium in the vitreous. Trans Am Ophthalmol Soc 1931;29:416.  Back to cited text no. 5
    
6.
Byrnes VA. Eyelash buried in clear lens substance. Am J Ophthalmol 1949;32(Pt 1):847-50.  Back to cited text no. 6
    
7.
Fish LA, Ragen MT, Smith RE, Lean J. Propionibacterium acnes lens abscess after traumatic implantation of intralenticular cilia. Am J Ophthalmol 1988;105:423-4.  Back to cited text no. 7
    
8.
Kozart DM, Yanoff M, Katowitz JA. Tolerated eyelash embedded in the retina. Arch Ophthalmol 1974;91:235-6.  Back to cited text no. 8
    
9.
Humayun M, de la Cruz Z, Maguire A, Dangel ME, Stark WJ, Green WR, et al. Intraocular cilia. Report of six cases of 6 weeks' to 32 years' duration. Arch Ophthalmol 1993;111:1396-401.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2]



 

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