Ulus Travma Acil Cerrahi Derg. 2023; 29(7): 830-833 | DOI: 10.14744/tjtes.2023.62019

Intraocular foreign body in the anterior chamber angle misdiagnosed as herpetic stromal keratitis

Hassan Haidar¹, Esra Biberoðlu Çelik², Semra Akkaya Turhan^2
1School of Medicine, Marmara University, Ýstanbul-Türkiye
²Department of Ophthalmology, Marmara University Pendik Educational and Research Hospital, Ýstanbul-Türkiye

We report a case of a metallic intraocular foreign body (IOFB) retained in the anterior chamber (AC) angle that was masquerading as herpetic stromal keratitis. A 41-year-old male construction worker was referred to our ophthalmology clinic with the complaint of consistent blurred vision for 3 days in his left eye. He had no history of ocular trauma. The best-corrected visual acuity was found to be 10/10 in the right eye and 8/10 in the left eye. On slit-lamp examination of the anterior segment, the right eye was normal, while the left eye showed unilateral corneal edema and scarring, anterior lens capsule opacification, +2 cells in the AC, and the Seidel test was negative. Fundus examination was normal bilaterally. Despite there not being history of it, we still suspected ocular trauma considering the patient’s occupational risk. Consequently, an orbital computed tomography imaging was performed which revealed a metallic-IOFB in the inferior iridocorneal angle. On the second follow-up day, the corneal edema regressed, and a gonioscopic examination of the affected eye was performed, showing a small foreign body embedded in the inferior iridocorneal angle of the AC. Subsequently, the IOFB was surgically removed using Barkan lens, and excellent visual results were achieved. This case emphasizes the importance of considering IOFB in the differential diagnosis of patients with unilateral corneal edema and anterior lens capsule opacification. Fur-thermore, the presence of IOFB should be definitely excluded in patients with occupational risk of ocular trauma even if there is no history of trauma. More awareness about the proper use of eye protection should be raised to circumvent penetrating ocular-trauma.

Keywords: Anterior capsule opacification, anterior chamber; corneal edema; herpetic keratitis; intraocular foreign body; ocular trauma.

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Herpetik stromal keratit olarak yanlýþ taný konmuþ ön kamara açýsýnda göz içi yabancý cisim olgusu

Hassan Haidar¹, Esra Biberoðlu Çelik², Semra Akkaya Turhan^2
1Marmara Üniversitesi Týp Fakültesi, Ýstanbul, Türkiye
²Marmara Universitesi Pendik Egitim Arastirma Hastanesi, Goz Hastaliklari Anabilim Dali, Ýstanbul, Türkiye

Herpetik stromal keratit gibi bulgu gösteren, ön kamara açýsýnda yerleþmiþ metalik intraoküler yabancý cisim (IOFB) olgusunu sunuyoruz. Sol gözünde 3 gündür bulanýk görme þikayeti olan 41 yaþýnda, inþaat iþçisi erkek hasta herpetik stromal keratit tanýsý ile merkezimize sevkedildi. Hastanýn anamnezinde travma öyküsü yoktu. Yapýlan muayenede en iyi düzeltilmiþ görme keskinliðinin sað gözde 10 /10, sol gözde 8/10 olduðu görüldü. Biyomikroskopik ön segment muayenesinde sað göz doðaldý. Sol gözde korneal ödem ve skar, ön kamarada +2 hücre, lens ön kapsülde noktasal kesafet izlendi. Seidel testi negatif idi. Fundus muayenesi bilateral doðaldý. Hastadan mesleði nedeniyle travmadan þüphelenilerek çekilen orbita bilgi-sayarlý tomografisinde intraoküler yabancý cisim saptandý. Takibinin 2. gününde kornea ödemi gerileyen hastanýn yapýlan gonyoskopik muayenesinde inferior iridokorneal açýda yabancý cisim görüldü. Hasta operasyona alýnarak Barkan lensi yardýmýyla açýdaki yabancý cisim çýkarýldý. Travma öyküsü olmasa bile travma açýsýndan þüpheli hastalarda kornea ödemi, lens kesafeti gibi muayene bulgularý olduðunda intraoküler yabancý cisim varlýðý düþü-nülmeli ve mutlaka ekarte edilmelidir. Riskli meslek grubunda olan kiþiler koruyucu gözlük kullanýmý konusunda bilinçlendirilmelidir.

Anahtar Kelimeler: Göz içi yabancý cisim, herpetik keratit, kornea ödemi; oküler travma; ön kamara; ön kapsül opaklaþmasý.

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