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Cilium Implanted in the Cornea
NOTES, CASES, INSTRUMENTS CILIUM IMPLANTED IN T H E CORNEA W M . T.
DAVIS, M.D. AND FREDERICK McC. MORRISON, M.D. WASHINGTON,
D.C.
A unique case of foreign body in the cornea has recently been under obser vation at the Episcopal Eye, Ear and Throat Hospital. Since a careful survey of the literature upon this subject has failed to discover a report of a similar case, it is believed to be sufficiently rare to merit a brief description. On October 31, 1933, a middle aged negress presented herself complaining of photophobia, lacrymation, a sensa tion of burning and of disturbed visual acuity of the right eye. These symp toms, mild at first, but becoming progressively more severe, were said to have extended over a period of some five weeks. Local treatment had led to no relief. The history was otherwise entirely uninformative; previous disturbance of any nature (other than presbyopic manifestations) were denied, and all attempts to elicit a history of trauma met with failure. Upon external examination with the aid of the loupe, a moderately severe degree of blepharitis squamosa was found. The lids were apparently other wise normal, as were the tarsal and bulbar conjunctivae, the pupillary re flexes, the ocular rotations, and the tear sacs. At the limbus, however, between "5 and 6 o'clock" there was found a small bleb, from which a fine gray band ap proximately 2 mm. in width, extended nearly to the center of the cornea. No further details were to be seen with the loupe. There was no stain to be ob served after the use of fluorescein. Under the slitlamp, using direct il lumination, a gradually diminishing zone of infiltration was seen upon each side of a more heavily infiltrated gray band. A blood vessel was found to oc cupy a radial position upon each side of this band. Between these vessels, and
lying nearly in the middle of the zone of infiltration there was seen an ex tremely thin black line, apparently con tinuous, although obscured in several portions by infiltrate. Detailed exami nation of this black line was best ac complished by reflected illumination with the slitlamp. It was now seen that the end nearer to the corneal center was pointed, while the remainder was of nearly uniform width. The pointed, or more centrally located portion of the dark line lay very deep, occupying a position approximately three-fourths of the thickness of the cornea, while the peripheral end was just under the epithelium. No evidence of intraocular reaction was found. A diagnosis of cilium in the cornea was made, and three days after the first visit the more superficial portion of the foreign body was removed. Microscopi cal examination confirmed the diagno sis. After subsidence of reaction from the first operation, the deeper parts of the cilium were removed. Healing proceeded without incident, and after two weeks the zone of infil tration was greatly reduced. Unfortu nately, the patient has failed to report for subsequent examination. In the literature examined, we have found fewer than one hundred reports of corneal foreign bodies involving a cilium. These, without exception, in volved trauma and penetration into the anterior chamber. In the absence of a history of trauma we are forced to the conclusion that a cilium, in all prob ability loosened by blepharitis, had fal len into the lower cul-de-sac, and had been mechanically forced through the limbus at the site of the bleb, into the lamellae of the cornea, in which posi tion it was found. 927 Farragut Square. A N E W TEST T Y P E EDWIN S. MUNSON,
M.D.
N E W YORK
After some years of experience and experimenting with different kinds of 746
DAVIS, M.D. AND FREDERICK McC. MORRISON, M.D. WASHINGTON,
D.C.
A unique case of foreign body in the cornea has recently been under obser vation at the Episcopal Eye, Ear and Throat Hospital. Since a careful survey of the literature upon this subject has failed to discover a report of a similar case, it is believed to be sufficiently rare to merit a brief description. On October 31, 1933, a middle aged negress presented herself complaining of photophobia, lacrymation, a sensa tion of burning and of disturbed visual acuity of the right eye. These symp toms, mild at first, but becoming progressively more severe, were said to have extended over a period of some five weeks. Local treatment had led to no relief. The history was otherwise entirely uninformative; previous disturbance of any nature (other than presbyopic manifestations) were denied, and all attempts to elicit a history of trauma met with failure. Upon external examination with the aid of the loupe, a moderately severe degree of blepharitis squamosa was found. The lids were apparently other wise normal, as were the tarsal and bulbar conjunctivae, the pupillary re flexes, the ocular rotations, and the tear sacs. At the limbus, however, between "5 and 6 o'clock" there was found a small bleb, from which a fine gray band ap proximately 2 mm. in width, extended nearly to the center of the cornea. No further details were to be seen with the loupe. There was no stain to be ob served after the use of fluorescein. Under the slitlamp, using direct il lumination, a gradually diminishing zone of infiltration was seen upon each side of a more heavily infiltrated gray band. A blood vessel was found to oc cupy a radial position upon each side of this band. Between these vessels, and
lying nearly in the middle of the zone of infiltration there was seen an ex tremely thin black line, apparently con tinuous, although obscured in several portions by infiltrate. Detailed exami nation of this black line was best ac complished by reflected illumination with the slitlamp. It was now seen that the end nearer to the corneal center was pointed, while the remainder was of nearly uniform width. The pointed, or more centrally located portion of the dark line lay very deep, occupying a position approximately three-fourths of the thickness of the cornea, while the peripheral end was just under the epithelium. No evidence of intraocular reaction was found. A diagnosis of cilium in the cornea was made, and three days after the first visit the more superficial portion of the foreign body was removed. Microscopi cal examination confirmed the diagno sis. After subsidence of reaction from the first operation, the deeper parts of the cilium were removed. Healing proceeded without incident, and after two weeks the zone of infil tration was greatly reduced. Unfortu nately, the patient has failed to report for subsequent examination. In the literature examined, we have found fewer than one hundred reports of corneal foreign bodies involving a cilium. These, without exception, in volved trauma and penetration into the anterior chamber. In the absence of a history of trauma we are forced to the conclusion that a cilium, in all prob ability loosened by blepharitis, had fal len into the lower cul-de-sac, and had been mechanically forced through the limbus at the site of the bleb, into the lamellae of the cornea, in which posi tion it was found. 927 Farragut Square. A N E W TEST T Y P E EDWIN S. MUNSON,
M.D.
N E W YORK
After some years of experience and experimenting with different kinds of 746