A 13-year-old girl initially diagnosed with recurrent HLA-B27–associated anterior uveitis was ultimately found to have an eyelash lodged in the anterior chamber angle. After surgical removal, the inflammation resolved, and uveitis did not recur during 2 years of follow-up.
The case, published in Case Reports in Ophthalmology, illustrates how an intraocular foreign body (IOFB) can remain undetected when another potential cause of unilateral uveitis has been identified.
Researchers at Zhongshan Ophthalmic Center, Sun Yat-Sen University, reported that the patient had experienced redness, pain, and decreased vision in her right eye for 3 months. She had tested positive for HLA-B27 and was treated with systemic and topical corticosteroids and immunosuppressive therapy, but uveitis recurred 4 times. She reported no ocular trauma.
At referral, best-corrected visual acuity (BCVA) was 20/250 in the affected eye. Slit-lamp examination showed keratic precipitates, 3+ anterior chamber cells, and hypopyon, with no visible corneal scar or entry wound. Testing for infectious and autoimmune causes was negative except for HLA-B27 positivity.
After topical and subconjunctival corticosteroid treatment, most inflammation subsided within 1 week, revealing a subtle iris protrusion at the 5 o’clock position. Ultrasound biomicroscopy showed peripheral anterior synechiae and a hyperreflective focus embedded in the angle recess, consistent with an IOFB.
Surgery revealed a thin, black structure approximately 2 mm long and 0.1 mm wide, consistent with an eyelash. Ten days after removal, BCVA improved to 20/33 and the anterior chamber was quiet. At 2 years, BCVA was 20/20 with no recurrent uveitis.
Researchers noted that HLA-B27 positivity does not exclude other causes of ocular inflammation. Intraocular eyelashes can also produce highly variable inflammatory responses, ranging from prolonged asymptomatic retention to iridocyclitis or endophthalmitis. In this case, the eyelash was associated with 4 episodes of uveitis over 3 months.
The researchers emphasized repeat examination after inflammation subsides and ultrasound biomicroscopy when an anterior-segment foreign body is suspected. A negative trauma history or absence of a visible entry wound does not exclude an IOFB because a small penetrating corneal injury may go unnoticed and self-seal.
Source: Case Reports in Ophthalmology
