Cilium in anterior chamber with an intact globe: Is it possible?

The presence of retained intraocular cilium following injury to the eye is a rare condition. We are presenting a case of 30 year old male reported to us with the complaints of mild eyeache in his right eye follwing ocular injury by electric wire two months back. He was treated elsewhere with a combination of topical antibiotic and steroid therapy. On gross examination, right eyelid and adnexa were normal, including healthy cilia and lid margin. His best corrected visual acuity was 20/40 and 20/20 in right and left eye respectively. Anterior segment examination of the right eye revealed a full length cilium in the anterior chamber, flare and cells 1+ in the right eye but surprisingly no apparent entry wound or scar was seen in the cornea. Evidence of iris injury was seen during slit lamp examination as an atrophic area at 4 o’ clock position of the right eye. On retroillumination, linear iris transillumination defect resembling peripheral iridectomy like defect was seen. The media and the fundus were normal. Without any evidenceof entry wound is it possible? In such senario, what to do? Should we wait and watch or should we proceed for removal of cilium. Though surgical removal of cilium is not mandatory considering its relatively inert status, in our opinion it is best to remove to avoid subsequent sequelae i.e uveitis, posterior synechias, iris cyst and localized anterior subcapsular cataract . Hence to avoid it, we decided to surgically remove the cilium. Moreover, surgical removal now a days is very safe due to advancement of microsurgical procedure and the removal of the cilium helped to rule out any other fallacy, and confirm the clinical diagnosis with evidence. Side port was made with 15 degree blade. Viscoelastic was injected into the AC and around the cilium. It was then grabbed with Uttrata forceps. Viscoelastic was removed by irrigation-aspiration. On table, a linear iris transillumination defect was revealed on retroillumination during irrigation and aspiration at the same site, which was otherwise difficult to detect. Side port wound was hydrated. Intracameral vancomycin was injected. This is a very rare scenario, presence of cilium in the anterior chamber without any evidence of injury in the outer coat of the eyeball. It can be assumed that, a tiny opening on the limbus was caused by a wire which avulsed a single cilium during its trajectory, and the cilium entered into the anterior chamber along with the wire. The wire injured the iris and came out along the same entry wound, but the cilium was left behind in anterior chamber. The entry wound healed without any scar, due to stem cells at the limbus, and so when the patient came for eye examination after two months, no evidence of injury was found on the outer coat of the globe.

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