A perforating corneal injury associated with the presence of cilia in the anterior chamber is uncommon1,2; rarer still is fingernail trauma as the cause of the corneal perforation.3 Herein we describe this extraordinary occurrence of corneal perforation that resulted from a sports injury.
A 30-year-old man experienced pain and decreased vision in the left eye after sustaining a fingernail injury one day earlier from a fellow player while playing the game of Kabadi. Kabadi, a popular sport on the Indian subcontinent, is a contest between 2 teams of 5 to 10 persons per team in which each side seeks physically to capture members of the opposing team and pull them over a line separating the 2 teams. The game involves extensive running and wrestling, and somewhat resembles the North American game of capture-the-flag.
Findings from the slitlamp examination revealed a 3-mm sealed corneal laceration at the 8-o'clock position, with moderate corneal edema. One cilium was protruding from the corneal wound and another, surrounded by an exudative membrane, was in the anterior chamber. There was a severe inflammatory reaction in the anterior chamber, with a 2-mm hypopyon mixed with blood. There was also an iridodialysis at the site of the injury (Figure 1).
Slitlamp photograph of the left eye with corneal laceration at the 8-o'clock position and associated iridodialysis. A cilia can be seen protruding out of the laceration, while another cilia is seen in the anterior chamber across the pupil with surrounding exudation and hypopyon.
In the operating room, the cilium protruding from the corneal laceration was removed with a jeweler's forceps. The anterior chamber cilium could be manipulated into the corneal wound with an intracameral 2% methylcellulose injection, and it was removed easily. The corneal laceration was repaired with 3 No. 10-0 nylon sutures. Cultures from the exudative membrane around the intraocular cilium revealed no bacterial growth. Postoperatively, the patient was treated with topical 0.3% ciprofloxacin and 0.1% betamethasone phosphate eyedrops in addition to oral ciprofloxacin and prednisolone. The anterior chamber inflammation resolved over several days. Two weeks later, the visual acuity was 6/36, and a rosette posterior subcapsular cataract became evident (Figure 2). During the ensuing 4 months, the patient had recurring anterior uveitis, only partially controlled with topical steroids, and a dense cataract developed. Surgery for the cataract is being deferred because of the continuing uveitis.
Postoperative photograph at 2 weeks with sutured corneal laceration. Note the quiet anterior chamber and early traumatic cataract.
Fingernail trauma usually causes only corneal abrasions and recurrent corneal erosions3 and rarely produces corneal perforation. Though the presence of an intraocular cilium associated with a penetrating injury caused by metal wire has been described,2 to the best of our knowledge, a corneal perforation with an intraocular cilium secondary to fingernail trauma has not been previously reported. Our patient probably sustained an injury to the eyelid margin and cornea simultaneously from the long fingernails of the fellow player, and an associated vigorous blink may have forced a cilium from the lid margin into the corneal perforation and anterior chamber.
Intraocular cilia, which can be found anywhere in the eye, including the anterior chamber, posterior chamber, lens, vitreous, and retina, are usually well tolerated, with periods as long as 32 years reported.1 An acute inflammatory reaction observed in a patient with an intraocular cilium probably is secondary to the impact of the trauma (perforation and concussion) and its resultant anterior chamber exudation when the patient is seen shortly after the injury.
Corresponding author: Ritu Arora, MD, D-1, Nizamuddin West, New Delhi-110 013 India.
Mde la Cruz
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