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Unsuspected Foreign Body in Lens
NOTES, CASES, INSTRUMENTS UNSUSPECTED FOREIGN BODY IN LENS. IRA A.
ABRAHAMSON,
M.D.
CINCINNATI, OHIO.
K. G., clerk, age 22. Unable to see out of right eye. History: Negative up to one year ago, when patient had an attack of acute catarrhal conjunctivitis, which lasted for about three days. Vision afterward not impaired. At the time the patient thought a foreign body was in the right eye, but the attending physician could not find any. General history: negative. On July 20, while playing hand ball, patient noticed that the right eye be gan to blur and shortly afterward photophobia and blepharospasm set in. No pain or lacrimation noted. Upon covering left eye, he was able to see only outlines of objects. The patient is certain he received no injury to the eye, and could see perfectly before this occurrence. Examination showed the patient ap parently in good health, lid movements unimpaired. Conjunctiva clear. R. E. vision 20/20 minus 1. Media are clear: Pupillary reaction to light, accommo dation and consensual present. Fundus normal. Tension normal. Refraction: plus 0.25 cyl. axis 90°. L. E. vision fingers at 10 inches. Conjunctiva clear. Opacity in the cornea, the size of a small pin head, situated about two mm. above the center. Slight depression, base smooth and pigmented, apparent ly superficial and old; no signs of in jection present or past. Anterior cham ber somewhat shallow. Color of iris good, no deposits, pupillary reaction to light present. On focal illumination, lens appears gray, opaque, swollen thruout. Ly ing embedded in the anterior capsule, at about four o'clock on the dial, 5 mm. from the limbus, is a highly pig mented, spindle shaped deposit or ob ject. Running from it to almost the equator, a rust colored streak of stain is noted. Another deposit is seen at about 9 o'clock, which is smaller and less dense. Both deposits are out of
37
direct line with the corneal abrasion. By means of the stereoscopic loupe, both the outlines of the object and stain can be seen distinctly. X-ray pic ture disclosed no foreign body. Comment. This case is presented be cause of the following misleading fea tures. 1. No history of any recent trauma. 2. Opacity on cornea was not on a line with lens opacity. 3. Cor neal opacity did not have the appear ance of having been a perforating wound. 4. X-ray picture returned ne gative. It is known that the crystalline is wonderfully tolerant of foreign bodies. So much so, that it will sometimes re tain perfect transparency for months, or even years, with one embedded sharply within its substance. It would not therefore be illogical to reason that the presence of the foreign body dated from the time the patient was told he had a catarrhal conjunctivitis 18 months previously, and that it lay embedded in the anterior capsule un dergoing oxidation, and weakening the capsule at that point. Of course, iron being readily oxidizable, would ordi narily make it more potent for evil than any of the noble metals, or even zinc or lead, but its position rendered tolerance to decomposition better. Later, during the strain of playing hand ball, the capsule ruptured, thus admitting the aqueous contact with the lens substance, resulting in the opacity of the lens. Treatment. The patient was taken to the hospital where the eye was pre pared. The tip of the Hirschberg hand magnet was applied to the cornea, and immediately a slight shock was felt. On the removal of the magnet, the for eign body was seen lying on the iris. An incision was then made with a keratome close to the iridic angle, facilitat ing the removal of the foreign body. The latter was grasped with iris for ceps and withdrawn from the anterior chamber. When seen six weeks later, the lens had completely absorbed, and the pa tient had made an uneventful recovery.
ABRAHAMSON,
M.D.
CINCINNATI, OHIO.
K. G., clerk, age 22. Unable to see out of right eye. History: Negative up to one year ago, when patient had an attack of acute catarrhal conjunctivitis, which lasted for about three days. Vision afterward not impaired. At the time the patient thought a foreign body was in the right eye, but the attending physician could not find any. General history: negative. On July 20, while playing hand ball, patient noticed that the right eye be gan to blur and shortly afterward photophobia and blepharospasm set in. No pain or lacrimation noted. Upon covering left eye, he was able to see only outlines of objects. The patient is certain he received no injury to the eye, and could see perfectly before this occurrence. Examination showed the patient ap parently in good health, lid movements unimpaired. Conjunctiva clear. R. E. vision 20/20 minus 1. Media are clear: Pupillary reaction to light, accommo dation and consensual present. Fundus normal. Tension normal. Refraction: plus 0.25 cyl. axis 90°. L. E. vision fingers at 10 inches. Conjunctiva clear. Opacity in the cornea, the size of a small pin head, situated about two mm. above the center. Slight depression, base smooth and pigmented, apparent ly superficial and old; no signs of in jection present or past. Anterior cham ber somewhat shallow. Color of iris good, no deposits, pupillary reaction to light present. On focal illumination, lens appears gray, opaque, swollen thruout. Ly ing embedded in the anterior capsule, at about four o'clock on the dial, 5 mm. from the limbus, is a highly pig mented, spindle shaped deposit or ob ject. Running from it to almost the equator, a rust colored streak of stain is noted. Another deposit is seen at about 9 o'clock, which is smaller and less dense. Both deposits are out of
37
direct line with the corneal abrasion. By means of the stereoscopic loupe, both the outlines of the object and stain can be seen distinctly. X-ray pic ture disclosed no foreign body. Comment. This case is presented be cause of the following misleading fea tures. 1. No history of any recent trauma. 2. Opacity on cornea was not on a line with lens opacity. 3. Cor neal opacity did not have the appear ance of having been a perforating wound. 4. X-ray picture returned ne gative. It is known that the crystalline is wonderfully tolerant of foreign bodies. So much so, that it will sometimes re tain perfect transparency for months, or even years, with one embedded sharply within its substance. It would not therefore be illogical to reason that the presence of the foreign body dated from the time the patient was told he had a catarrhal conjunctivitis 18 months previously, and that it lay embedded in the anterior capsule un dergoing oxidation, and weakening the capsule at that point. Of course, iron being readily oxidizable, would ordi narily make it more potent for evil than any of the noble metals, or even zinc or lead, but its position rendered tolerance to decomposition better. Later, during the strain of playing hand ball, the capsule ruptured, thus admitting the aqueous contact with the lens substance, resulting in the opacity of the lens. Treatment. The patient was taken to the hospital where the eye was pre pared. The tip of the Hirschberg hand magnet was applied to the cornea, and immediately a slight shock was felt. On the removal of the magnet, the for eign body was seen lying on the iris. An incision was then made with a keratome close to the iridic angle, facilitat ing the removal of the foreign body. The latter was grasped with iris for ceps and withdrawn from the anterior chamber. When seen six weeks later, the lens had completely absorbed, and the pa tient had made an uneventful recovery.