Report of endophthalmitis caused by Paradictyoarthrinium diffractum after plant trauma: A case involving left enucleation.

During outdoor work in April 2022, a 48-year-old man was stabbed by a tree branch and underwent intraocular foreign body extraction and repair of the scleral wound with sutures and amniotic membrane graft at a local hospital. Steroid therapy with prednisone was prescribed after a diagnosis of uveitis. Vitrectomy was performed in June 2023; a fungal culture was positive, and ITS sequencing identified the organism as Paradictyoarthrinium diffractum. Empiric antifungal therapy did not have an effect, and, because of deterioration of the condition, the left eye was enucleated in October 2023. P. diffractum is a mangrove host-specific saprophytic fungus that has not been reported in humans.

Alterações oculares decorrentes de picada de abelha na córnea / Ocular changes due to corneal bee sting

RESUMO O propósito deste estudo foi reportar as alterações oculares observadas após picada de abelha com ferrão retido na córnea. Destacamos o tratamento e o desfecho de uma lesão de córnea incomum e sua patogênese. Trata-se de relato de caso e revisão da literatura de lesões oculares por picada de abelha. Paciente do sexo feminino, 63 anos, procurou atendimento oftalmológico de urgência devido à picada de abelha na córnea do olho direito há 6 dias. Queixava-se de embaçamento visual, dor e hiperemia ocular. Apresentou acuidade visual de vultos no olho afetado. Ao exame, notaram-se hiperemia moderada de conjuntiva bulbar, edema corneano com dobras de Descemet e presença do ferrão alojado na região temporal, no estroma profundo da córnea. A paciente foi internada para ser abordada no centro cirúrgico sob anestesia geral. Durante a cirurgia, o ferrão teve que ser retirado via câmara anterior, mediante a realização de uma paracentese e uma lavagem da câmara anterior, com dupla via e solução salina balanceada. Ainda não existe na literatura um tratamento padrão na abordagem de pacientes com lesões oculares por picada de abelha, sendo importantes a identificação e o reconhecimento precoce de possíveis complicações que ameacem a visão.

ABSTRACT The purpose of this study was to report the ocular changes observed after a bee sting with a stinger retained in the cornea. We show the treatment and outcome of an unusual corneal injury and its pathogenesis. This is a case report and literature review of ocular injuries caused by bee stings. A 63-year-old female patient sought emergency ophthalmic care because of a bee sting on the cornea of her right eye six days before. She complained of blurred vision, pain, and ocular hyperemia. She had glare sensitivity on visual acuity in the affected eye. Examination revealed moderate hyperemia of the bulbar conjunctiva, corneal edema with Descemet's folds and a stinger lodged in the temporal region, in the deep stroma of the cornea. The patient was admitted to the operating room under general anesthesia. During surgery, the stinger had to be removed via the anterior chamber, by performing a paracentesis and washing the anterior chamber with a double flushing and balanced saline solution. There is still no standard treatment in the literature for patients with eye injuries caused by bee stings, and early identification and recognition of possible sight-threatening complications is important.

Occult intraocular aluminium foreign body causing rhegmatogenous retinal detachment: a case report.

BACKGROUND: Ocular trauma is complex and varied, and some occult intraocular foreign bodies (IOFBs) can lead to uncommon symptoms and signs. We report a case of rhegmatogenous retinal detachment (no obvious wound, no pain, no intraocular infection or other symptoms) caused by an occult intraocular aluminium foreign body, which could have been easily missed. CASE PRESENTATION: A 42-year-old male presented to the outpatient department of our hospital complaining of fluttering black dots and decreased vision in his left eye that began 3 months earlier. He was diagnosed with "floaters" at a community hospital. He denied a history of ocular trauma or previous surgery. The cornea and lens of the left eye were clear. A small patch of pigmentation was noted in the temporal sclera. Fundoscopy revealed macula-off retinal detachment. After mydriasis, elliptical holes were seen in the peripheral retina at 2:30, and a suspicious hyperreflective strip was found under the anterior lip of the retina by Goldmann three-mirror contact lens examination; the strip was confirmed to be an IOFB by orbital CT. The IOFB was removed through pars plana vitrectomy without any complications. CONCLUSION: Unlike iron and copper IOFBs, aluminium IOFBs are more inert and more likely to be missed. For people with special occupations (construction workers, mechanics, etc.), when abnormal pigmentation of the sclera is found, the possibility of foreign bodies in the eye should be considered. In the process of disease diagnosis and treatment, it is necessary to ask for a detailed history, including occupation history and practice, and perform careful physical and targeted examinations. Such comprehensive analysis regarding the above information will minimize the chance of missed diagnosis.Awareness of occult IOFB in high risk occupations and prompt referral to a retinal surgeon is of outmost importance.

Spontaneous resolution of a wooden foreign-body granuloma in the conjunctiva of a child.

A conjunctival foreign-body (FB) granuloma may result following trauma with synthetic and non-synthetic materials including organic and non-organic objects. Children usually manifest with FB granulomas that develop due to inoculation of FBs from soft toys, blankets or woollen clothes. Encapsu- lation of these FBs following a granulomatous inflammatory response results in a nodular swelling in the conjunctiva. Reports of a wooden FB granuloma in the conjunctiva in children are anecdotal. A 5-year-old boy suffered an un- witnessed direct ocular trauma to his left eye (OS) with a wooden arrow while playing. He developed redness and nodular swelling at the inferotemporal aspect of the OS without any visual complaints. The diagnosis of a wooden FB granuloma is a challenge to ophthalmologists and may go undetected in children who neglect their symptoms. It characteristically presents as a unilateral conjunctival nodule. Surgical excision is the definitive management. However, spontaneous extrusion of the FB might be observed due to protective blinking and tearing mechanisms in the eye.

Risk Factors for Failure of Final Anatomic Surgical Reattachment in Retinal Detachments From Combat Ocular Trauma.

BACKGROUND AND OBJECTIVE: The goal of this study was to determine the anatomic outcome of traumatic retinal detachment (RD) from combat ocular trauma. MATERIALS AND METHODS: Retrospective study of patients sustaining a traumatic RD in Operation Iraqi Freedom and Operation Enduring Freedom who were evacuated to Walter Reed Army Medical Center from 2001 to 2011. The Fisher exact test, Wilcoxon rank sum test, and Agresti and Coull methods were used for analyses. RESULTS: There were 143 eyes of 134 patients in which a traumatic RD developed, of a total of 890 eyes of 652 patients in the Walter Reed Ocular Trauma Database. Based on our results, predictors for failure to reattach the retina include maculaoff status (P = .0002), open-globe injury (P = .03), proliferative vitreoretinopathy postoperatively (P = .002), and presence of hyphema (P = .02). Intraocular foreign body and time to initial retinal surgery did not increase risk for failure. Thirty-four percent (34%) of eyes failed to be reattached. CONCLUSIONS: Traumatic RD due to injury sustained in a combat zone resulted in poor prognosis, with 82.09% of eyes with RD having a best-corrected visual acuity worse than 20/200. The anatomic success of RD repair was shown to be 65.71%, likely owing to the severity of the injuries, concomitant systemic injuries, and delayed surgical intervention. [Ophthalmic Surg Lasers Imaging Retina 2022;53:493-501.].

[A case of ocular siderosis caused by iron ore].

A patient complained of vision loss of his left eye which was crushed by iron ore for 11 months. The cornea of the injured eye was thin and swollen, and a large amount of rust-like material was observed to be deposited. An intraocular foreign body was found by orbital CT. During vitrectomy, a piece of metal sheet was found near the ora serrate, and the intraocular structure was severely damaged, and characterized by vitreous brown turbidity, a white optic disc, occlusion of blood vessels in the fundus, and peripheral retinal atrophy with degeneration. The patient was diagnosed as ocular siderosis in the left eye.

Unilateral Ocular Siderosis Bulbi Due to Missed Metallic Intraocular Foreign Body Masquerading as Anisocoria of Neurological Origin: A Case Report.

BACKGROUND Ocular siderosis is an uncommon cause of vision loss due to a retained ferrous intraocular foreign bodies (IOFB) that cause iron deposition in ocular tissues. The most common manifestations are cataract formation, diffuse pigmentary changes of the retinal pigment epithelium, iris heterochromia, dilated pupils, secondary glaucoma, iritis, and cystoid macular edema. CASE REPORT We report a case of 38-year-old man who presented with a left dilated pupil and visual field defect. Neurological examination results were normal. Brain magnetic resonance imaging revealed a gross artifact at the site of the left globe. The visual field test showed a peripheral arcuate nasal visual field defect in the left eye. Ophthalmic examination revealed peripheral pigmentary changes and a black elongated and elevated lesion located very anterior and inferior-temporal and attached to the retina with fibrous tissue. A computed tomography scan revealed a 1×1-mm-round hyperdense IOFB in the left vitreous cavity. The diagnosis of siderosis bulbi secondary to a missed IOFB was established. The patient underwent a pars plana vitrectomy for removal of the IOFB. Two weeks later, rhegmatogenous retinal detachment developed, and repair with silicon oil injection was done. One year after the last operation, the best corrected visual acuity in the left eye was 6/120, with normal intraocular pressure and an attached posterior pole. CONCLUSIONS This case highlights the importance of investigating for a retained IOFB in cases of unilateral retinitis pigmentosa changes.

Retained iron intraocular foreign body with late onset siderotic glaucoma: a clinical challenge.

Siderotic glaucoma is a rare and challenging clinical scenario caused by a retained iron intraocular foreign body (IOFB), which results in irreversible vision loss. Presented here is a case of secondary open-angle glaucoma in a 36-year-old man that was refractory to maximal medical therapy. A meticulous history and careful clinical examination revealed that he had a penetrating trauma 15 years ago, a self-sealed corneal entry wound, open angles, a retained encapsulated metallic IOFB and siderosis bulbi. Removal of the foreign body not only controlled intraocular pressure, but also improved vision.

Analysis of the Effect of Intraocular Lens Implantation on Retinal Nerve and Postoperative Nursing Outcome Based on Ultrasound Imaging.

Traumatic cataract is a common complication of ocular contusion. Caused by various forms of trauma, the course and prognosis of traumatic cataract are also different. Intraocular lens (IOL) implantation is the most effective treatment at the present time and can provide good visual quality and near, medium, and far vision. In this study, an adaptive medical ultrasound image denoising algorithm was constructed based on the biological vision mechanism and was applied to observe IOL implantation and postoperative care of 30 patients with traumatic cataract. Results showed that eyesight could be restored to the original healthy state after IOL implantation, and eyesight was close to normal 3 months after surgery. The corresponding noise pixel block of the noise reduction algorithm was obviously the lowest. A total of 30 patients (9 patients with contusion, 13 patients with intraocular foreign body, and 8 patients with perforation) were treated with aspheric and multifocal IOL to achieve the expected outcome. The noise reduction algorithm constructed in this study effectively reduced the speckle noise of ultrasound images, improved the clarity of ultrasound images, and achieved the effective observation of medical nursing outcome after traumatic cataract IOL implantation. After IOL implantation, the retinal nerves of patients with traumatic cataract were affected to different degrees.

Heterocromia de íris: uma revisão das condições que podem afetar a pigmentação iridiana / Heterochromia: a review of conditions that may affect iris pigmentation

RESUMO A íris é responsável pela cor dos olhos. Ela ainda realiza o controle da quantidade de luz que penetra no olho pela pupila. Variações nos genes de cada indivíduo, além da quantidade e da qualidade de melanina na íris, determinam a cor dos olhos. A heterocromia é caracterizada por diferenças na coloração da íris de um mesmo indivíduo, sendo, na maioria das vezes, benigna. Existem basicamente três tipos de heterocromia de íris: central, setorial e completa. A heterocromia de íris pode ter como causa alterações genéticas e congênitas, relacionadas ou não a síndromes específicas, como a de Sturge-Weber, a de Waardenburg, a de Parry-Romberg e a de Horner congênita. Há também causas adquiridas, como doenças ou lesões, trauma ocular e corpos estranhos intraoculares, uso de certas medicações tópicas, siderose ocular, irites ou uveítes como a síndrome uveítica de Fuchs, dentre outras. Diante de um paciente com heterocromia de íris, deve-se entender o contexto e o curso clínico desse sinal, pois pode se tratar de uma alteração de pigmentação benigna ou existir uma doença base em curso, que requer terapêutica específica. Este artigo de revisão de literatura visa abordar as principais etiologias relacionadas à heterocromia de íris, além de discorrer sobre a anatomia e a fisiologia da coloração iridiana e sobre a fisiopatologia de suas possíveis alterações.

ABSTRACT The iris is responsible for eye color and controls the amount of light that enters the eye through the pupil. Variation in each individual's genes, besides the quantity and quality of melanin in the iris, determine eye color. Heterochromia is characterized by different colors of irises in the same individual, and it is benign in most cases. There are basically three types of heterochromia: central, partial and complete. Heterochromia can be caused by genetic and congenital alterations, which may or may not be related to specific conditions, such as Sturge-Weber syndrome, Waardenburg syndrome, Parry-Romberg syndrome and congenital Horner syndrome. It may be associated to acquired causes like diseases or injuries, such as eye trauma and intraocular foreign bodies, use of some topical medications, ocular siderosis, iritis or uveitis, such as Fuchs´ uveitis, among others. When assessing a patient with heterochromia, one must understand the context and clinical course of this signal, since it may be a benign pigmentation disorder or there may be an underlying disease, which requires specific therapy. This literature review article was set out to address the main etiologies related to heterochromia, in addition to describing the anatomy and physiology of the iris color and the pathophysiology of possible alterations.

Foreign body episcleral suture granulomas mimicking nodular anterior scleritis.

Scleritis is an idiopathic condition that may sometimes be associated with systemic immunological like disorders rheumatoid arthritis, Wegener's granulomatosis and systemic lupus erythematosus. A variety of foreign material has been reported to result in granuloma formation in various parts of the body. We report a case of inflamed episcleral granulomas mimicking severe nodular anterior scleritis in a healthy Caucasian woman who underwent strabismus surgery in her childhood. Foreign body reaction on the episcleral/scleral surface is rare. It is extremely unusual for a non-absorbable suture that was used for childhood strabismus surgery to incite an acute inflammatory episode mimicking nodular anterior scleritis as in our case. As the strabismus surgery was performed 37 years prior to her presentation with anterior scleritis, we were unable to obtain any details of this surgical procedure. We presume that a non-absorbable suture like braided polyester or prolene may have been used.

Carcinoma epidermoide córneo-conjuntival. Presentación de un caso / Squamous cell, corneal-conjunctival carcinoma of. Case report

RESUMEN Se presentó el caso de un paciente masculino de 60 años, blanco, que fue atendido en la Consulta de Oftalmología, del Hospital "Dr. Mario Muñoz", del municipio de Colón, provincia de Matanzas. Refirió que llevaba aproximadamente 20 días, con sensación de cuerpo extraño en el ojo izquierdo, enrojecimiento, secreción constante, fotofobia y una lesión que le había aumentado de tamaño durante este período; la que se tornaba dolorosa durante el parpadeo. Se decidió realizar este trabajo con el objetivo de mostrar los beneficios obtenidos al concluir el tratamiento aplicado a este tipo de tumor (AU).

ABSTRACT The authors present the case of a white male patient, aged 60 years, who assisted the Consultation of Ophthalmology of the Hospital "Dr. Mario Muñoz", of the municipality of Colon. He referred feeling a foreign body in the left eye for already 20 days, presence of redness, constant secretion, photophobia and a lesion that had grown during that period, painful when blinking. The authors decided to write this article with the objective of showing the benefits obtained with the applied treatment in this kind of tumor (AU).

Ocular siderosis resulting from a retained intralenticular metallic foreign body.

Intraocular foreign bodies are a potential factor threatening with loss of vision. The development of cataract and symptoms of ocular siderosis are the most common signs of ferrous metal entering the eye. We present a case of a 45-year-old man who reported to the hospital for planned cataract surgery. He denied the possibility of any past eye injury. Despite this, apart from the cataract, X-ray and CT scans confirmed the presence of an intralenticular foreign body and symptoms of ocular siderosis. Cataract surgery was successfully performed using phacoemulsification, and the metallic foreign body was removed. Intraocular foreign body symptoms may be overlooked by patients and even physicians and may occur with considerable delay. Hence, in patients with indirect symptoms of penetrating eye injury, the presence of an intraocular foreign body should not be ruled out, even if the patient denies this possibility.

Indirect choroidal neovascularization secondary to a posterior-segment intraocular foreign body - case report.

BACKGROUND: We reported a rare case of indirect choroidal neovascularization (CNV) secondary to a posterior-segment intraocular foreign body (IOFB) that was not located in the area of direct injury but in the fovea. After intravitreal injections (IVIs) of aflibercept, the choroidal neovascularization (CNV) lesion disappeared and vision improved. CASE PRESENTATION: A 26-year-old male patient suffered from a fast-shot metallic IOFB in his right eye. He underwent primary corneal repair, pars plana vitrectomy, IOFB removal and an IVI of antibiotics in the right eye. Two weeks later, cataract surgery was performed on the right eye for traumatic cataract after an episode of acute phacolytic glaucoma. The best-corrected visual acuity (BCVA) of the right eye improved to 20/20 5 months after the first surgery. However, the vision of the right eye worsened suddenly with metamorphopsia 1 year after the first surgery. Color fundus images showed a whitish lesion with faint retinal hemorrhage and surrounding sensory elevation. Fluorescein angiography (FA) revealed a lesion with early- and late-phase severe leakage. Optical coherence tomography (OCT) demonstrated a CNV lesion with surrounding subretinal fluid. The patient received an IVI of aflibercept every 8 weeks for 3 times. Finally, the BCVA of the right eye improved to 20/25. CONCLUSIONS: For rare cases of fovea-spared injury by a metallic IOFB, it is still necessary to pay close attention to the foveal microstructure to avoid possible CNV formation. Treatment with IVIs of anti-VEGF, aflibercept, as early as possible could provide good visual outcomes.

Intraorbital Graphite Foreign Body With a Delayed Presentation of Optic Neuropathy.

Traumatic penetrating injuries to the orbit from pencils, while uncommon, have a plethora of presentations, both acute and delayed. With the most incidents occurring in the pediatric population where obtaining a detailed history is difficult, the ability to effectively evaluate and diagnose these injuries is cumbersome, yet important. The authors report a patient who presented with optic neuropathy, blepharoptosis, and strabismus 10 months after an orbital injury with pencil graphite.

Bristle Worm-Induced Keratouveitis: A Case Report.

PURPOSE: To report keratouveitis arising from corneal penetration by a bristle worm seta (bristle). METHODS: We report on a 64-year-old woman presenting with uniocular pain, redness, reduced vision, discharge, and pustular rash of the hands after cleaning out her marine aquarium containing bristle worms and rubbing her eye. RESULTS: Slit-lamp biomicroscopy showed pseudomembranous conjunctivitis, corneal punctate erosions, stromal infiltrate, and edema, but no visible foreign body. The anterior chamber developed 3+ cells with hypopyon within 24 hours. Laboratory testing of corneal and hand samples was negative. In vivo confocal microscopy revealed a hair-like seta in the anterior corneal stroma, 25 to 105 µm wide, with surrounding inflammatory cells. Anterior chamber washout was performed. Topical prednisolone 0.5% was commenced, and corneal edema gradually resolved over 3 months. CONCLUSIONS: Bristle worms thrive as detritivores in marine aquarium sediment. Aquarium owners risk touching their setae during tank cleaning. Ophthalmia nodosa describes ocular reaction to caterpillar, vegetable, and spider hairs: features include posterior migration of hairs, granulomatous inflammation, and uncertain prognosis. Eye specialists should be alerted to the possibility of bristle worm-induced ophthalmia nodosa. Confocal microscopy may be useful in identifying microscopic setae.

Predictive factors of visual outcome in posterior segment intraocular foreign body.

BACKGROUND: To identify the predictive factors for visual outcomes of patients with posterior segment intraocular foreign body (IOFB) after open-globe injury. METHODS: A retrospective, interventional study was conducted to evaluate consecutive patients with retained posterior segment IOFB who underwent vitrectomy over a 10-year period from 2007 to 2016. Multivariate linear regression analysis was used to identify the potential predictive factors for final visual outcomes. RESULTS: Forty-two patients were evaluated, with predominantly males (97.6%) and mean age 37.21 years. Hammering on metal (47.62%) was the major mechanism of injury. The majority of foreign bodies were metallic (95.24%) with a mean dimension of 4.3 mm. Twenty-four (57.14%) patients initially presented with a Snellen visual acuity <6/60. After surgery, 19 (45.24%) eyes had final visual outcomes of 6/12 or better; however, visual outcomes worse than 6/60 were documented in 17 (40.48%) eyes. Multivariate linear regression analysis revealed that the occurrence of retinal detachment (RD; p<0.01) and larger IOFB dimension (p=0.02) independently predicted worse final visual outcomes after adjusting for age and initial VA. Eyes with entry wounds located posteriorly into the sclera significantly increased the risk of RD compared to eyes with entry wounds involving cornea only (p=0.03). There was no association between time interval for IOFB removal and development of endophthalmitis. CONCLUSION: RD and larger IOFB dimension are significant predictive factors associated with worse final visual outcomes. Increased time to IOFB removal is not associated with either a higher risk of endophthalmitis or worse visual outcomes.