Q J Med 2015; 108:251–252 doi:10.1093/qjmed/hcu174 Advance Access Publication 19 August 2014
Clinical picture Scleral granuloma revealing intraocular foreign body An ophthalmological examination by slit lamp revealed a punctiform corneal opacity near the limbus with a sclera nodule and a yellowish round protruding formationin the anterior chambe with a fibrinous appearance reminiscent of a granuloma (Figure 1a). The lens, vitreous and back of the eye were normal. Confronted with this clinical picture, we suspected a foreign body of vegetal origin at the ciliary body or the iridocorneal angle with a probable fungal infection. The gonioscopic review did not identify the foreign body. The X-ray of the eye socket was normal, as was the ocular B-mode ultrasound with a 10-Hz probe. The patient was treated with corticosteroids and localized antibiotic therapy, and surgical exploration was planned to search for a possible foreign body. However, the evolution was marked by regression of the granuloma while under treatment, with the fistulization and spontaneous expulsion of the foreign body (Figure 1b). Foreign bodies of the anterior segment are often more visible, and the exact definition of their position makes it more accessible for surgery.2 Their
Figure 1. (a) Picture showing the aspect of granuloma. (b) Picture showing the foreign body (plant’s thorn).
! The Author 2014. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]
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When confronted with any ocular trauma, the presence of an intraocular foreign body should be considered even in the absence of an obvious wound because of the risk of infection and metallosis.1 The presence of foreign bodies in certain localizations can be difficult to detect, in particular the anterior chamber angle and ciliary body. We report the atypical case of a child with sclera granuloma revealing a foreign body. This case involves 6-year-old child who consulted the emergency department for red eye in the right eye. The left eye was unaffected. The patient’s medical history briefly noted an accidental injury to the right eye caused by a plant’s thorn that had occurred a month earlier but which had been left untreated. The patient only sought treatment after the right eye became red and inflamed. At the emergency department, the patient was treated with anti-inflammatory drugs and topical antibiotics, but there was no improvement. The patient was then admitted to our medical training program.
252
Clinical Picture
prognosis is clearly better than that of retinoidvitreous foreign bodies. These aspects must not make us forget the risk of infection engendered by foreign bodies, especially if it is intraocular. The particularity of our clinical case lies in the mode of discovery and the unusual location of the foreign body. Photographs and text from: Z. Jaja, Service d’ophtalmologie A, Hospital des spe´cialite´s de Rabat (Maroc); M. Laghmari, Service d’ophtalmologie A, Hospital des spe´cialite´s de Rabat (Maroc);
R. Daoudi, Service d’ophtalmologie A, Hospital des spe´cialite´s de Rabat (Maroc). email: [email protected] Conflict of Interest: None declared.
References 1. Burillon C. Gain Ph. Traumatismes du segment anterieur de l’œil. Encycl Med Chir. Ophtalmologie 1993; 21700-A-10:21. 2. Burillon C. Corps etranger du segment anterieur. J Fr Ophtalmol 2001; 24:751–57.
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Clinical picture Scleral granuloma revealing intraocular foreign body An ophthalmological examination by slit lamp revealed a punctiform corneal opacity near the limbus with a sclera nodule and a yellowish round protruding formationin the anterior chambe with a fibrinous appearance reminiscent of a granuloma (Figure 1a). The lens, vitreous and back of the eye were normal. Confronted with this clinical picture, we suspected a foreign body of vegetal origin at the ciliary body or the iridocorneal angle with a probable fungal infection. The gonioscopic review did not identify the foreign body. The X-ray of the eye socket was normal, as was the ocular B-mode ultrasound with a 10-Hz probe. The patient was treated with corticosteroids and localized antibiotic therapy, and surgical exploration was planned to search for a possible foreign body. However, the evolution was marked by regression of the granuloma while under treatment, with the fistulization and spontaneous expulsion of the foreign body (Figure 1b). Foreign bodies of the anterior segment are often more visible, and the exact definition of their position makes it more accessible for surgery.2 Their
Figure 1. (a) Picture showing the aspect of granuloma. (b) Picture showing the foreign body (plant’s thorn).
! The Author 2014. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]
Downloaded from by guest on November 13, 2015
When confronted with any ocular trauma, the presence of an intraocular foreign body should be considered even in the absence of an obvious wound because of the risk of infection and metallosis.1 The presence of foreign bodies in certain localizations can be difficult to detect, in particular the anterior chamber angle and ciliary body. We report the atypical case of a child with sclera granuloma revealing a foreign body. This case involves 6-year-old child who consulted the emergency department for red eye in the right eye. The left eye was unaffected. The patient’s medical history briefly noted an accidental injury to the right eye caused by a plant’s thorn that had occurred a month earlier but which had been left untreated. The patient only sought treatment after the right eye became red and inflamed. At the emergency department, the patient was treated with anti-inflammatory drugs and topical antibiotics, but there was no improvement. The patient was then admitted to our medical training program.
252
Clinical Picture
prognosis is clearly better than that of retinoidvitreous foreign bodies. These aspects must not make us forget the risk of infection engendered by foreign bodies, especially if it is intraocular. The particularity of our clinical case lies in the mode of discovery and the unusual location of the foreign body. Photographs and text from: Z. Jaja, Service d’ophtalmologie A, Hospital des spe´cialite´s de Rabat (Maroc); M. Laghmari, Service d’ophtalmologie A, Hospital des spe´cialite´s de Rabat (Maroc);
R. Daoudi, Service d’ophtalmologie A, Hospital des spe´cialite´s de Rabat (Maroc). email: [email protected] Conflict of Interest: None declared.
References 1. Burillon C. Gain Ph. Traumatismes du segment anterieur de l’œil. Encycl Med Chir. Ophtalmologie 1993; 21700-A-10:21. 2. Burillon C. Corps etranger du segment anterieur. J Fr Ophtalmol 2001; 24:751–57.
Downloaded from by guest on November 13, 2015
