Purpose:

The finding of an anterior chamber cilium after small incision cataract surgery is rare, with only five prior cases being found on literature review. This case with photos and video documentation adds to the number of case reports and highlights that unexpected findings such as this can be seen on the first postoperative day exam.

Methods:

A 69 year Chinese Female underwent routine phacoemulsification and intraocular lens (model SA60AT, Alcon) placement in her right eye using a 2.75 mm superonasal clear corneal incision and 1.1 mm inferotemporal paracentesis. On postoperative day one, uncorrected vision was 20/20 and intraocular pressure was 13. Figure 1 and 2 show a large eyelash in the inferior anterior chamber with a horizontal orientation. There was minimal anterior chamber cell and flare and the cornea was clear. Removal of the eyelash the same day was uneventful. On follow up checks her uncorrected vision was 20/20 with normal intraocular pressure, a quiet anterior chamber and a clear cornea.

Results:

Video 1 shows no eyelash in the anterior chamber or tear film at the end of the case. Since the lash orientation was horizontal and the pointed end proximal to the paracentesis location, I conjecture it entered via mechanisms described by previous reports. Eye rubbing may distort the incision with significant pressure allowing the cilium to be entrapped in a corneal wound. Blinking and eyelid squeezing result in dramatic intraocular pressure fluctuation and may have resulted in alteration of the incision allowing the lash to enter the anterior chamber. Video 2 shows the eyelash removal. The clear corneal wound is opened and forceps remove the eyelash from the anterior chamber.

Conclusions:

This case reminds us that cilia rarely find their way into the anterior chamber after routine cataract surgery. It reinforces patient education to avoid eye rubbing after surgery as multiple reports have proposed that cilia may enter the eye while the wounds are healing.