Year : 1963 | Volume
: 11 | Issue : 1 | Page : 17--18
Cilia in anterior chamber
Department of Ophthalmology, G. R. Medical College, Gwalior., India
S P Srivastava
Department of Ophthalmology, G. R. Medical College, Gwalior.
|How to cite this article:|
Srivastava S P. Cilia in anterior chamber.Indian J Ophthalmol 1963;11:17-18
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Srivastava S P. Cilia in anterior chamber. Indian J Ophthalmol [serial online] 1963 [cited 2020 Feb 20 ];11:17-18
Available from: http://www.ijo.in/text.asp?1963/11/1/17/38831
To find a cilium, as an intraocular foreign body in the anterior chamber is rare and interesting,-Muller, (1894) 5 in 30,000 new cases; Popov, (1941) 3 in 143,471 eye patients; Sitchevska and Payne (1949) 2 in 374,741 eye patients. The author himself has seen the present case for the first time in his eleven years of experience in largely attended medical college hospitals at Agra, Bhopal and Gwalior. Cilia may enter the anterior chamber in perforating injuries of the eye ball, when they are cut or torn off from the lid margin and are passively carried into the anterior chamber along with a foreign body entering the eve ball or with the object causing the perforating injury, either through a corneal or limbal wound. It may also be very rarely implanted inadvertently into the anterior chamber during an intraocular operation like cataract extraction.
A cilium is most frequently seen in the anterior chamber with one end embedded in the iris. It may rarely lie free in the anterior chamber. If the lens is injured one end of the cilium may be stuck in the lens or the lens capsule. Sometimes, as in the present case, one end of the cilium may lie in between the lips of the corneal wound near the limbus and the other either free in the anterior chamber or entangled in the iris. The reaction of the eye to a retained cilium in the eye varies widely. The following list of reactions has been collected by Duke Elder (1954) from the literature.
1. If contaminated by infection, an acute pyogenic inflammation may be set up.
2. It may remain inert without exciting any reaction and may only be discovered accidentally.
3. A delayed inflammation may sometimes develop even after many years which may even be so destructive as to end in blindness.
4. Plastic irridocyclitis may occur.
5. It may excite the formation of a granulomatous tumour.
6. As a, rarity even sympathetic ophthalmitis may occur.
7. Cystic formation may occur as a typical delayed complication of a retention of an eyelash in the anterior chamber.
In cases where an eye lash lies inert for a long time, changes may occur in the structure of the eyelash. It may undergo splitting or separation of cuticle. Partial resorption, with depigmentation and bleaching may occur. While its complete disappearance has been reported as a rarity.
Whether the cilium should be removed in treating a case of cilia in anterior chamber or left as such is difficult to decide. The possibility that it may remain inert indefinitely is high. On the other hand tendency to inflammation either early or late and the probability of cystic formation points to the advisability of removal. When its surgical removal appears to be easy no delay should be exercised in removing it, but if it is located at a place whence removal would he difficult, the risks should be weighed against the adoption of a policy of inactivity. [Duke Elder (1954b)].
The removal of cilia itself from the anterior chamber is by no means easy. The collapse of anterior chamber, because of early outflow of aqueous, tendency of the iris to prolapse, entanglement of the lash in the iris and haemorrhage from the iris obscuring the view, make the extraction sometimes difficult.
A Hindu, male child, aged 8 years was brought to the Ophthalmic department J. A. Hospital, Gwalior, with the history that the child was struck in the right eye by an arrow shot by one of his playmates while playing bow and arrow, on the previous day.
On examination of the right eye, the lids were slightly swollen. There was circumcorneal congestion. In the cornea there was a perforating, irregular cut on the temporal side about 4 mm. long and one mm. inside the limbus. The edges of the cut were slightly oedematous and infiltrated. The anterior chamber was clear, but was collapsed on the lateral side near the wound due to the entanglement of a little iris in the inner part of the wound without prolapse. The pupil was drawn laterally towards the cut and was pear shaped. On examination by a binocular loupe, an eyelash was seen lying in the anterior chamber. Although the proximal end of the cilium was not visible in the wound externally, it was seen extending from just behind the corneal wound. The whole eyelash was lying along the surface of the lower part of the iris, slightly pressing it backwards. The lens was normal. Tension was low. The child could count fingers from about 2 meters. Fundus was not examined at that time. The left eye was normal.
As one end of the cilium appeared to lie in the inner part of the corneal wound it was thought proper to attempt an extraction. The child was taken up for operation under general anaesthesia. On slightly separating the lips of the corneal wound with an iris repositor, one end of the cilium could be seen. Using a binocular loupe, it could be caught with fine pointed serrated forceps, after a few attempts and was removed. The iris was freed from the lips of the cut.
The wound was stitched with one corneal stitch. Air was injected in the anterior chamber. A sub-conjunctival injection of penicillin was given and the eye bandaged after putting atropine and prednisolone eye ointment. The recovery was uneventful. The eye became quiet in eight days time.
The corneal stitch was removed on the eleventh day and the child was discharged. Vision in the left eye as recorded after one week was 6/18 P. The fundus was normal.
Considering the frequency with which perforating injuries occur, the rarity with which cilia are seen in the anterior chamber, is remarkable. It is probably the high velocity and suddenness with which a foreign body usually strikes the eye ball, that the reflex closure of lids lags behind so that the particle misses contact with eyelashes. Duke Elder (1954c) states that it is only on rare occasions that the foreign body brushes the ciliary margin or lid closure occurs simultaneously with the impact, in which case the cilia may be carried into the anterior chamber.
In treating such cases, as is borne out by good recovery in the present case, it is always desirable to attempt an early removal of the eyelash in those cases where its surgical removal appears to be easy, without probable damage to the eye.
A case of cilium in the anterior chamber, after perforation from a bow and arrow injury in an 8 year-old child is described. Good recovery followed early removal. Relevant literature is reviewed.
|1||Duke Elder, S. (1954a) "Text book of Ophthalmology" Vol. VI p. 6224 Henry Kimpton, London. (1954b) Ibid. Vol. VI p. 6229, (1954c) Ibid Vol. VI p, 6223.|
|2||Muller, (1894) wein, Kl. W., 7, 231.|
|3||Popov, (1941) Vestn. O., 18, 439.|
|4||Sitchevska, and Payne, (1949) Amer. J. of Ophthal. 34, 982.|