|Year : 2003 | Volume
| Issue : 2 | Page : 184-185
Vegetative intraocular foreign body of 25 years' duration.
G Bhaduri, A Ghosh
Regional Institute of Ophthalmology, Medical College and Hospital, Kolkata, India
Regional Institute of Ophthalmology, Medical College and Hospital, Kolkata
Source of Support: None, Conflict of Interest: None
Retained intraocular organic foreign bodies, particularly wooden bodies, are frequently encountered in ophthamlologic practice. We treated a patient with a retained intraocular foreign body - a single splinter from a broom - which had remained in the eye for 25 years.
Keywords: Retained intraocular foreign body, broom splinter in anterior chamber, 25 years′ duration
|How to cite this article:|
Bhaduri G, Ghosh A. Vegetative intraocular foreign body of 25 years' duration. Indian J Ophthalmol 2003;51:184-5
Retained intraocular foreign bodies account for a small but significant number of ocular trauma cases. This type of injury occurs in occupational contexts, and many cause serious complications in both early and late stages of injury. Foreign bodies in the anterior chamber of the eye are uncommon, making up only about 15% of all intraocular foreign bodies. We report an unusual case of a retained intraocular foreign body - a splinter from a broom - in the anterior chamber of the right eye.
| Case report|| |
A 30-year-old male farmer presented at the Regional Institute of Ophthalmology, Medical College, Calcutta with dimness of vision in the right eye in March 1997. He had been injured in the right eye with a broom around the age of 5. He was treated by a local ophthalmologist. The pain and redness diminished after 6 weeks of treatment but his vision was significantly reduced, although spectacles had been prescribed in childhood. On examination, the unaided visual acuity in his right eye was perception of light and projection of rays. Vision with the prescribed correction (+10 DSph) was 6/60 (Snellen chart). Further examination, showed that the lids were healthy and there was no congestion in the conjunctiva. A triangular white corneal leucoma extending from the 7 o' clock position with its apex towards 11 o'clock was visible. The base of the triangle was 3 mm wide, a faint macular opacity in the cornea was seen extending from the apex of the triangle to 11 o'clock. Slitlamp examination revealed no aqueous cells or flare in the anterior chamber. The depth of the anterior chamber was 5 mm. A brown coiled foreign body was seen in the anterior chamber. There was no perforation of the iris although a few atrophic patches were observed on the surface. The pupil reacted briskly except around the 3 o'clock position because of posterior synechia with thickened capsule. Direct ophthalmo-scopy showed a faint fundal glow through the centre of pupil; the peripheral part of pupil was hazy due to the thickened capsule. Intraocular pressure in the right eye was 14 mm Hg. The patient was initially reluctant to undergo any surgery but after persuasion, a coiled broom sliver 35 mm long was taken out through a limbal incision under local anaesthesia. He refused intraocular lens implantation and the postoperative period was uneventful. Later, aphakic correction (+9.00 DSph +0.50 DCyl at 180°) was prescribed, and vision improved to 6/18 (Snellen chart). The patient was informed about diplopia and loss of binocularity.
| Discussion|| |
The velocity and point of entry determine the site at which a foreign body comes to rest in the eye. Non-metallic foreign bodies usually have a lower velocity than metallic; they penetrate the cornea and tend to remain in the anterior chamber. The reaction set up in the anterior chamber depends on the extent of irritation caused to the adjacent structures, that is, the corneal endothelium, iris and lens., The reaction to vegetative matter varies, and depends largely on concurrent introduction of microorganisms at the time of injury. Mild inflammation secondary to sporophytic yeast or fungi has been reported. Contaminated vegetable matter frequently produces an acute pyogenic panophthalmitis. A common pathogenic reaction of a vegetative foreign body is chronic proliferative granulomatous response with formation of an inflammatory mass in or on the iris., Retained intraocular foreign bodies may lead to the formation of pearly epidermoid cyst. However in the absence of infection vegetative matter akin to wood may behave as a relatively inert foreign body. Several reports in the literature describe eyes remaining quiet for years with retained intraocular foreign bodies.,,
The vegetative element in this case, that is, the splinter from the broom is nothing but the dried midriff of the palm or coconut leaf. These sticks are very sharp and are used in bunches of 30 or so to sweep dirt in rural areas. Children often use the individual stick in mock sword fights. In the course of such play, they may suffer various injuries. A broom splinter 35 mm long, coiled in the anterior chamber of right eye was retained for 25 years without untoward reaction. Traumatic cataract following this penetrating injury was lysed, leading to aphakia with formation of cataract. The coiled stick was removed through a limbal incision though IOL implantation would have been ideal to maintain binocular vision and prevent diplopia. We did not do this as the patient did not consent[Figure - 1].
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[Figure - 1]
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