The black eye.

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

Anterior-segment photograph of left eye showing a visibly quiet eye with blackish pigmentation of cornea with multiple yellowish deposits

Questions

What is the diagnosis?

Fungal corneal ulcer

Chemical injury

Corneal tattoo

Blast injury with retained intracorneal foreign bodies.

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

Corneal scrapping

Ultrasound B-scan

Computed tomographic orbit to rule out foreign body

Anterior-segment optical coherence tomography.

What is the next plan of management in this patient?

Start antifungal medication

Give copious saline wash

Prescribe lubricating eye drops

Optical keratoplasty.

Answers

C

B

C.

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

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.