Contact Lens & Anterior Eye 37 (2014) 388–389

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Case report

Traumatic insertion of eyelashes into corneal stroma Edward J. Casswell a,∗ , Evgenia V. Anikina a , Ali A. Mearza a,b a b

The Western Eye Hospital, London NW1 5QH, United Kingdom Department of Ophthalmology, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, United Kingdom

a r t i c l e

i n f o

Article history: Received 23 March 2014 Received in revised form 25 April 2014 Accepted 29 April 2014 Keywords: Eyelashes Cilia Corneal stroma Trauma

a b s t r a c t An unusual case of eyelashes being traumatically inserted into the corneal stroma is presented. A 75year-old hit her right eye with her own fist, presenting with intra-corneal eyelashes. All remained entirely within the cornea, with no breach of the endothelium. They seemed to have tracked there first through the superior conjunctiva and then the superior limbus. The lashes were surgically removed, with good visual recovery. The authors present a short review of intra-ocular eyelash insertion. © 2014 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

1. Case report

2. Discussion

A 75 yr old Russian lady presented with a red, painful right eye after unfortunately hitting herself with her own fist while kneading dough. She had no previous ophthalmic history and other than hypertension had no significant medical history. On examination, visual acuity (VA) was 6/36 in the right eye (RE) and 6/9 in the left eye (LE). She had a superior subconjunctival haemorrhage affecting the right eye, a central epithelial abrasion and four intra-stromal eyelashes affecting the superior cornea (Fig. 1). The lashes were entirely within the corneal stroma, with no evidence of entry into the anterior chamber and were associated with intra-stromal blood (Fig. 2). Dilated examination revealed previously undiagnosed pseudo-exfoliation syndrome with normal intra-ocular pressures. Surgical removal of the lashes was performed under local anaesthetic. The more central lashes were removed through the corneal epithelium and the two lashes that involved the limbus were removed via a small conjunctival peritomy. A further eyelash was found under the conjunctiva above the limbus. The patient was treated post-operatively with preservative-free chloramphenicol 0.5% and dexamethasone 0.1%. The patient’s VA improved to 6/12 at week 1 and to 6/9 at week 12. No post operative inflammation was noted.

Intra-ocular cilia have previously been reported but remain rare. As far as the authors are aware, this is the second case of cilia being embedded in the corneal stroma in the absence of prior surgery, penetrating injury or corneal laceration [1]. In this patient, the authors believe that blunt trauma to the half closed eyelid must have occurred to allow the lashes to enter the cornea via the superior limbal area. In this lady’s case, perhaps the blink reflex was inadequate allowing this unusual presentation.

∗ Corresponding author. Tel.: +44 777 3681323. E-mail address: [email protected] (E.J. Casswell).

Fig. 1. Anterior segment photo showing 4 intra-stromal corneal eyelashes and a superior subconjunctival haemorrhage.

http://dx.doi.org/10.1016/j.clae.2014.04.006 1367-0484/© 2014 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

E.J. Casswell et al. / Contact Lens & Anterior Eye 37 (2014) 388–389

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infection. In this case, the authors decided to remove the lashes to prevent the risk of keratitis and other possible sequelae. Cilium embedding into the corneal stroma is a very rare consequence of trauma. Funding The authors have no financial or proprietary interests in any material or method mentioned. References

Fig. 2. High magnification anterior segment photo showing 4 eyelashes embedded in the superior cornea, associated with intra-stromal blood.

Intra-ocular or intra-corneal cilia have been reported following cataract surgery [2], corneal transplantation [3] and laser in situ keratomileusis [4]. Similarly they have been reported following ocular trauma [5–7], all involving corneal penetrating injury. The consequences of intra-ocular cilium are variable. Cilia have been reported in the anterior chamber with no intra-ocular inflammation for up to 50 years [8]. Conversely, intra-corneal or intra-ocular cilia have been reported to lead to uveitis [9], endophthalmitis [10], iris cyst [11], corneal endothelial cell deficiency [12] and anterior lens opacification [13]. Given that patients can remain asymptomatic for many years, some ophthalmologists choose to observe these cases for signs of inflammation or secondary problems. However, others choose early removal to reduce the potential risk of inflammation or

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Traumatic insertion of eyelashes into corneal stroma.

An unusual case of eyelashes being traumatically inserted into the corneal stroma is presented. A 75-year-old hit her right eye with her own fist, pre...
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