Corneal epithelial ingrowth after perforating corneal injury: a case report
Abstract Background Epithelial ingrowth is a rare complication after ocular perforation and can become manifest many years after the primary trauma. Case presentation A 49-year-old patient presented with a positive Seidel test of unclear origin at her left eye, as well as a sharply defined anterior-...
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| Format: | Article |
| Language: | English |
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BMC
2022-12-01
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| Series: | BMC Ophthalmology |
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| Online Access: | https://doi.org/10.1186/s12886-022-02670-x |
| _version_ | 1827984806397345792 |
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| author | Adrien Quintin Loïc Hamon Fidelis A. Flockerzi Ursula Schlötzer-Schrehardt Matthias Dias Blak Berthold Seitz |
| author_facet | Adrien Quintin Loïc Hamon Fidelis A. Flockerzi Ursula Schlötzer-Schrehardt Matthias Dias Blak Berthold Seitz |
| author_sort | Adrien Quintin |
| collection | DOAJ |
| description | Abstract Background Epithelial ingrowth is a rare complication after ocular perforation and can become manifest many years after the primary trauma. Case presentation A 49-year-old patient presented with a positive Seidel test of unclear origin at her left eye, as well as a sharply defined anterior-stromal corneal scar at both eyes. Prior operations included a bilateral laser-assisted blepharoplasty 3 months earlier. The patient indicated to have been on holiday to France 5 months earlier, during an ongoing oak processionary moth caterpillars infestation. The examination using confocal microscopy confirmed a corneal perforation at the left eye and revealed corneal epithelial ingrowth capped with scarred stroma in both eyes. We performed a penetrating keratoplasty at the left eye. The scarred and perforated host cornea was divided into 4 pieces for further investigation: microbiology (negative), virology (negative), histology and transmission electron microscopy (TEM). Histology revealed differently structured epithelium, centrally inverted into the stroma through defects in Bowman’s layer. TEM revealed full thickness corneal perforation with an epithelial plug extending to the lower third of the cornea, but without evidence of epithelial cell migration into the anterior chamber. Our differential diagnosis of the unclear positive Seidel test with epithelial ingrowth was as follows: (1) corneal perforation by hairs of the oak processionary moth caterpillar, although no hairs could be found histologically; (2) corneal perforation during laser-assisted blepharoplasty, which may be supported by the presence of pigmented cells on the posterior surface of Descemet´s membrane, pointing to a possible iris injury. Conclusion Consequently, we highlighted that contact lenses can be useful, safe and inexpensive protective devices in upper eyelid procedures to protect the cornea against mechanical iatrogenic trauma. |
| first_indexed | 2024-04-09T23:04:47Z |
| format | Article |
| id | doaj.art-010dcac5ef034c6a8272c3eaed7b13c4 |
| institution | Directory Open Access Journal |
| issn | 1471-2415 |
| language | English |
| last_indexed | 2024-04-09T23:04:47Z |
| publishDate | 2022-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Ophthalmology |
| spelling | doaj.art-010dcac5ef034c6a8272c3eaed7b13c42023-03-22T10:43:58ZengBMCBMC Ophthalmology1471-24152022-12-012211810.1186/s12886-022-02670-xCorneal epithelial ingrowth after perforating corneal injury: a case reportAdrien Quintin0Loïc Hamon1Fidelis A. Flockerzi2Ursula Schlötzer-Schrehardt3Matthias Dias Blak4Berthold Seitz5Department of Ophthalmology, Saarland University Medical Centre (UKS)Department of Ophthalmology, Saarland University Medical Centre (UKS)Department of Pathology, Saarland University Medical Centre (UKS)Department of Ophthalmology, University of Erlangen-NürnbergDepartment of OphthalmologyDepartment of Ophthalmology, Saarland University Medical Centre (UKS)Abstract Background Epithelial ingrowth is a rare complication after ocular perforation and can become manifest many years after the primary trauma. Case presentation A 49-year-old patient presented with a positive Seidel test of unclear origin at her left eye, as well as a sharply defined anterior-stromal corneal scar at both eyes. Prior operations included a bilateral laser-assisted blepharoplasty 3 months earlier. The patient indicated to have been on holiday to France 5 months earlier, during an ongoing oak processionary moth caterpillars infestation. The examination using confocal microscopy confirmed a corneal perforation at the left eye and revealed corneal epithelial ingrowth capped with scarred stroma in both eyes. We performed a penetrating keratoplasty at the left eye. The scarred and perforated host cornea was divided into 4 pieces for further investigation: microbiology (negative), virology (negative), histology and transmission electron microscopy (TEM). Histology revealed differently structured epithelium, centrally inverted into the stroma through defects in Bowman’s layer. TEM revealed full thickness corneal perforation with an epithelial plug extending to the lower third of the cornea, but without evidence of epithelial cell migration into the anterior chamber. Our differential diagnosis of the unclear positive Seidel test with epithelial ingrowth was as follows: (1) corneal perforation by hairs of the oak processionary moth caterpillar, although no hairs could be found histologically; (2) corneal perforation during laser-assisted blepharoplasty, which may be supported by the presence of pigmented cells on the posterior surface of Descemet´s membrane, pointing to a possible iris injury. Conclusion Consequently, we highlighted that contact lenses can be useful, safe and inexpensive protective devices in upper eyelid procedures to protect the cornea against mechanical iatrogenic trauma.https://doi.org/10.1186/s12886-022-02670-xCorneal perforationEpithelial invasionOak processionary moth caterpillar hairLaser-assisted blepharoplastyCase report |
| spellingShingle | Adrien Quintin Loïc Hamon Fidelis A. Flockerzi Ursula Schlötzer-Schrehardt Matthias Dias Blak Berthold Seitz Corneal epithelial ingrowth after perforating corneal injury: a case report BMC Ophthalmology Corneal perforation Epithelial invasion Oak processionary moth caterpillar hair Laser-assisted blepharoplasty Case report |
| title | Corneal epithelial ingrowth after perforating corneal injury: a case report |
| title_full | Corneal epithelial ingrowth after perforating corneal injury: a case report |
| title_fullStr | Corneal epithelial ingrowth after perforating corneal injury: a case report |
| title_full_unstemmed | Corneal epithelial ingrowth after perforating corneal injury: a case report |
| title_short | Corneal epithelial ingrowth after perforating corneal injury: a case report |
| title_sort | corneal epithelial ingrowth after perforating corneal injury a case report |
| topic | Corneal perforation Epithelial invasion Oak processionary moth caterpillar hair Laser-assisted blepharoplasty Case report |
| url | https://doi.org/10.1186/s12886-022-02670-x |
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