Cilia

Its There But Where

Chief Author :- Dr. Minal Kaur

Presenting Author:- Dr. Pushkar Dhir

(The Tail of Wandering Cilia)

• Ms. X 16 year old SINGLE FEMALE , STUDENT by profession from New Delhi presented to OPD on 28 Jan 2015 with

C/o :- Pain(LE)

Waterring (LE)

Headache (Frontal) – Last few months

20 days

HISTORY

..

• APPARENTLY WELL 20 DAYS back prior when she started having

Pain was Dull In Nature, Present

Through Out The Day with same intensity , Non-Radiating & was not relieved on taking medication

Discharge was Watery in nature ,

scanty ,non purulent .

H/O injury with Broom Stick 25 days ago

RE LE

VA DISTANCE 6/6p 6/6pNEAR N-6 N-6ACCEPTANCE +0.50DC @180(6/6) +0.50DC @180 (6/6)

EOMNo Restriction in any Gaze No Restriction in any gaze

Associated with MILD PAIN

LIDS NORMAL NORMAL

CONJUNCTIVANORMAL

Inferior Bulbar Conjunctival Congestion with granuloma

formation and cilia impacted in it.

CORNEA CLEAR,STAIN -VE CLEAR,STAIN -VE

RE LE

AC QUIET, VH4 QUIET,VH4

Pupil Size & Reactn ~4mm/Normal reacting ~4mm/ Normal reacting

LensCLEAR Clear

IOP(Applanation,mm Hg) 12 12

Fundus Within Normal Limits Within Normal Limits

DISCUSSION• Cilia(eyelash) can be found at multiple abnormal places in

eye e.g

• Lacrimal Punctum/sac (11)• Conjunctiva(2)• Anterior chamber(1)• Anterior Lens Capsule (6)• Vitreous(5)

• Predisposing Conditions:- Post Phacoemulsification.(4)Scarring of conjunctiva(3).Trauma(7)

Cilia/Eyelash at

Various Places

CONSEQUENCES

Conjunctival Granuloma(9)

Iris cyst(10)

Corneal Endothelium Defeciency (8)

Quiet Eye

Management

• Cilia was removed with a suture removing forceps under topical anesthesia and

• Antibiotic e/d 4 times a day &• Lubricant e/d 4 times a day for 7 days was prescribed.

• On 1st Follow up:-• Patient eye was quiet and granuloma has started resolving.

REFERENCES1. L. H. Savin NOTES ON AN EYELASH CARRIED BY A PERFORATING INJURY

INTO THE POSTERIOR AQUEOUS CHAMBER Br J Ophthalmol. 1936 Nov; 20(11): 609–612.

2. J. Hamilton McIlroy AN EYELASH IN THE BULBAR SUBCONJUNCTIVAL TISSUE Br J Ophthalmol. 1921 February; 5(2): 68–69.

3. Hunts JH1, Patrinely JR, Matoba AY, Font RL. Conjunctival cilia entrapment: an unrecognized cause of ocular irritation. Ophthal Plast Reconstr Surg. 1997 Dec;13(4):289-92

4. Rofail M, Briner AM, Lee GA. Migratory intraocular cilium following phacoemulsification .Clin Experiment Ophthalmol. 2006 Jan-Feb;34(1):78-80

5. Teo L, Chuah KL, Teo CH, Teoh SC. Intraocular cilia in retinal detachment Ann Acad Med Singapore. 2011 Oct;40(10):477-9.

6. R. Graham Brown CASE OF AN EYELASH PERFORATING THE CORNEA AND ANTERIOR LENS CAPSULE Br J Ophthalmol. 1919 Apr; 3(4): 162–163.

7. Zuleyha Yalniz-Akkaya Post-traumatic cilia remaining inert in the anterior chamber for 50 years: a case report J Med Case Reports. 2011; 5: 527. Published online 2011 Oct 26. doi:  10.1186/1752-1947-5-527

8. Intraocular cilium causing corneal endothelium cell deficiencyWei Liu, Jian Ji Hui Liu Ruihua Wei, Shaozhen Zhao Tianjin Medical University Eye Hospital, Tianjin, China Cjo April 2013Volume 48, Issue 2, Pages e28–e29 .

9. Kiesel RD. Conjunctival granuloma due to an imbedded cilium. Am J Ophthalmol 1961; 51: 706–708

10. H B Hoh, M J Menage, and C Dean-Hart Iris cyst after traumatic implantation of an eyelash into the anterior chamber. Br J Ophthalmol. 1993 Nov; 77(11): 741–742.

11. R. Graham Brown Dacryolith formation around an eyelash retained in the lacrimal sac. Br J Ophthalmol. 1976 Oct;60(10):722-5.