Oman Journal of Ophthalmology

CLINICAL QUIZ
Year
: 2019  |  Volume : 12  |  Issue : 3  |  Page : 206--207

The black eye


Simar Rajan Singh, Sonam Yangzes, Jagat Ram 
 Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Correspondence Address:
Dr. Jagat Ram
Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh
India




How to cite this article:
Singh SR, Yangzes S, Ram J. The black eye.Oman J Ophthalmol 2019;12:206-207


How to cite this URL:
Singh SR, Yangzes S, Ram J. The black eye. Oman J Ophthalmol [serial online] 2019 [cited 2020 Feb 29 ];12:206-207
Available from: http://www.ojoonline.org/text.asp?2019/12/3/206/268910


Full Text



 Case Presentation



A 25-year-old female presented with itching in the left eye. She was referred as a case of fungal corneal ulcer and was on treatment for the same. There was a history of trauma to left eye 10 years ago and she had undergone an ocular surgery 5 years ago, but details of procedure were not available. On examination, the visual acuity in the right eye was 6/6 while the left eye had no perception of light. In the left eye, the lids and adnexa were normal with presence of diffuse blackish pigmentation over the cornea admixed with multiple yellowish deposits [Figure 1]. Anterior-chamber details were not visible. Posterior segment could not be evaluated. The right eye was grossly within normal limits.{Figure 1}

 Questions



What is the diagnosis?

Fungal corneal ulcerChemical injuryCorneal tattooBlast injury with retained intracorneal foreign bodies.

What is the next investigation you would like to order next?

Corneal scrappingUltrasound B-scanComputed tomographic orbit to rule out foreign bodyAnterior-segment optical coherence tomography.

What is the next plan of management in this patient?

Start antifungal medicationGive copious saline washPrescribe lubricating eye dropsOptical keratoplasty.

 View Answer

 Answers



CBC.

 Case Description



The patient has a poor ocular surface following corneal tattooing, done 5 years ago after ocular trauma. An ultrasonography should be done in these eyes to rule out any malignant pathology in the posterior segment. Given the absence of light perception in the eye, a sight restoring procedure like penetrating keratoplasty is not indicated. Such patients can simply be observed and lubricating drops prescribed for the uneven ocular surface causing the irritation. Corneal tattooing is an old cosmetic technique involving staining the anterior corneal stroma with sterile ink in eyes with poor visual potential.[1] Although tattooing is mostly offered to patients with end-stage opaque corneas, the procedure can also be done on eyes with good visual potential for symptomatic glare due to pathologies such as aniridia and large peripheral iridotomies.[2] The procedure involves impregnating the corneal stroma with a sterile-coloring agent. It can be done both by direct impregnation into the stroma via a tuberculin syringe [1] or after creating a lamellar pocket.[3] It can be complicated secondarily by corneal ulceration and the same should be recognized and treated early.[4]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.