When a tiny Sand Particle caused havoc!
Severe pain, redness, watering and blurring of vision in his right eye since 10 days brought Mr. Krishnan Nair, aged 31, to Dr. Vandana Jain. He vaguely remembered sand particles having fallen into his right eye a month ago. He did not have any systemic illness.
Mr. Krishnan’s eye sight was tested. While his distance and near vision was normal in his left eye, the vision in his right eye was so poor that he could not accurately perceive the presence of a light even 10 cm from his right eye (inaccurate projection of rays). Dr Jain examined his eyes and found that his lids showed marked edema (swelling).
There was a well-defined, dirty white, raised lesion at the border of the cornea with the sclera (called the limbus) measuring 2.5 x 2.5 mm and was painful to touch. Examination showed that the lesion had spread into his cornea (mid-stromal infiltrate 3-mm inside the limbus). The surrounding cornea showed swelling (stromal edema with folds in the Descemet’s membrane). B-Scan ultrasonography revealed an echo-free vitreous cavity with attached retina.
Based on the presence of severe pain, a tender nodular scleral lesion, and dirty-yellow granular exudates in the anterior chamber, Dr Jain diagnosed the patient as a case of scleritis (inflammation of the sclera) with corneal ulcer of caused by infection. Microbiology work-up of scraping from the lesion showed that it was infected with bacteria. (gram-positive bacilli and Nocardia asteroids). All other systemic examination and HIV blood tests were normal. Based on the smear results, treatment was started (Antibiotics for two months followed by steroid drops). Six weeks later the lesion had resolved and the best-corrected visual acuity in the right eye was 20/60.
Take Home Message:
(Not his real name)