Endophthalmitis due to 5 eyelashes, which

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Endophthalmitis due to 5 eyelashes, which entered
the vitreous during occurrence of perforated eye
injury
Yoshihide Nakai, Kyoko bessho, Yuko Shono,
Yoshimasa Nakai (Tokai eye Clinic, Tsu,
Japan) Finacial Interest is None.
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Purpose Endophthalmitis occured 2days after
scleral suturing of the perforated eye, so
vitrectomy was done, and 5 eyelashes were found.
After extraction of these eyelashes,
endophthalmitis improved. In this presentation,
we report a case which is very rare. Methods A
29-year-old man had iris prolapsed and scleral
perforation because of a wire which hit his left
eye. CT scanning, X-ray, B-mode, etc. revealed
no foreign body in the eye. On the day of the
examination, iridectomy and scleral suturing
were performed, and antibiotics were
administered. On the following day, number of
cells of the anterior chamber and vitreous body
were increased. Therefore, vancomycin
hydrochloride 1mg and ceftazide hydrate 2mg were
injected into the vitreous body. After that, the
opacity of the vitreous became further
exacerbated, which led to phacoemulsification
and vitrectomy 4 days after the injury.
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2nd January. An injury by a metal occured. On
the same day, the first medical examination was
done. The findings showed iris prolapse and
vitreous bleeding. The Retina couldnt be seen.
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A metalic foreign body couldnt be found by CT
and XP check.
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3rd January, 23am. Sclera suture was performed.
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6th January, ( 3days after operation). Inflammati
on became worse. So Vancomycin 1mg and
Ceftazidime Hydrate 2mg, Vitreous injection
were administered.
5th January, (2days after operation) Vitreous
inflammation increased particulary in the
periphery.
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7th January, (4 days after operation). Vitreous
inflammation and bleeding increased more. So
Vitrectomy was done, and a vitreous foreign
bodies (5 eyelashes) were removed.
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Eyelashes were removed from pals plana.
Pals plana
Eyelashes
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Eyelashes removed in the vitreous.
8th Jan.2009 (1day after Removal of foreign
bodies and Vitrectomy) Anterior Chamber
Vitreous opacity improved. Intra vitreous
injection of Isepamicin, Cefozopran
hydrochloride.
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5 extracted eyelashes
Eyelashes Keratin is the main ingredient.
Keratin is a protein. Bacteria and
filamentous bacteria ofen exist.
Fluid cultures of the anterior chamber and
vitreous were bacteria-negative. The PCR method
could not identify bacterial species.
914th Jan. Anterior Chamber Vitreous Opacity
improved more. 15th Jan L-Visual acuity
0.01(0.312D) 1st sep L-visual acuity
1.0(1.20.5Dcyl-1.0D180)
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Eyelashes in vitreous of perforated eye injury.
(3cases were repoted in the past)
1)Seawright AA etcIntravitreal cilia in phakic
penetrating eye injury Australian and New
Zealand Journa of pthalmology. 25133-135,2007
(2 cases) 2)Asako Kawaguchi, Yoshitsugu Inoue
Eyelashes in the posterior eye segment in a
case of penetrating eye injury.
58109-111,2004 (1 case)
Are they able to detect intravitreal eyelashes?
Its impossible to detect eyelashes by XP, CT,
MRI. B-mode Kawaguchi couldnt detect
eyelashes. Sea wright Its
possible to detect eyelashes in a turn, size and
the location of the injury? UBM
The degree of organization and reaching is bad.
Anterior segment OCT It isnt generally
available.
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Results During vitrectomy, 5 eyelashes were
detected in the ciliary pars plana near the
scleral perforation. After the eyelashes were
removed, the vitreous body was washed with
antibiotics. Fluid cultures of the anterior
chamber and vitreous body were
bacteria-negative. In addition, the PCR method
could not identify bacterial species. After the
operation, the opacities of the anterior chamber
and vitreous body were improved, and the visual
acuity became 20/400(20/2012D) 3 months after
vitrectomy. Conclusion Eyelashes are difficult
to detect by usual examinations. Therefore, even
if CT scanning, etc. reveal no foreign bodies in
perforated eyes, it is necessary to conduct
postoperative management. Patients showing
deterioration of the opacity of the vitreous by
injection of antibiotics into the vitreous need
to undergo vitrectomy immediately.