Korean J Ophthalmol.  2011 Apr;25(2):128-131. 10.3341/kjo.2011.25.2.128.

A Case of Retained Graphite Anterior Chamber Foreign Body Masquerading as Stromal Keratitis

• Han ER
• Wee WR
• Lee JH
• Hyon JY

• KMID: 1111875
• DOI: http://doi.org/10.3341/kjo.2011.25.2.128

Abstract

We report a case of a retained graphite anterior chamber foreign body that was masquerading as stromal keratitis. A 28-year-old male visited with complaints of visual disturbance and hyperemia in his right eye for four weeks. On initial examination, he presented with a stromal edema involving the inferior half of the cornea, epithelial microcysts, and moderate chamber inflammation. Suspecting herpetic stromal keratitis, he was treated with anti-viral and anti-inflammatory agents. One month after the initial visit, anterior chamber inflammation was improved and his visual acuity recovered to 20/20, but subtle corneal edema still remained. On tapering the medication, after three months, a foreign body was incidentally identified in the inferior chamber angle and was surgically removed resulting in complete resolution of corneal edema. The removed foreign body was a fragment of graphite and he subsequently disclosed a trauma with mechanical pencil 12 years earlier. This case showed that the presence of an anterior chamber foreign body should always be considered in the differential diagnosis of idiopathic localized corneal edema.

Keyword

Corneal edema; Foreign bodies; Graphite

MeSH Terms

Adult
Anterior Chamber/*injuries/pathology
Corneal Stroma/*pathology
Diagnosis, Differential
Eye Foreign Bodies/*diagnosis/physiopathology/surgery
Eye Injuries, Penetrating/*diagnosis/physiopathology/surgery
*Graphite
Humans
Keratitis/*diagnosis
Male
Ophthalmologic Surgical Procedures
Visual Acuity

Figure

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  Fig. 1 A slit lamp biomicroscopic finding on the patient's initial visit revealed conjunctival hyperemia, localized corneal stromal edema with epithelial microcysts, and moderate chamber inflammation. A focal mid-stromal scar at the temporal cornea was also noted.

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  Fig. 2 After five days of steroid treatment, stromal edema was decreased and the patient's vision improved to 20/20. Localized epithelial microcysts were still observed.

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  Fig. 3 At three months after initial visit, a previously unobserved foreign body was incidentally identified in the inferior angle of anterior chamber.

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  Fig. 4 Removed anterior chamber foreign body measuring about 0.5×1.5 mm in size.

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  Fig. 5 Energy dispersive X-ray spectroscopy of the removed foreign body revealed that it contains mainly elementary carbons, which implies that the foreign body is a broken graphite pencil lead.

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  Fig. 6 Two weeks after removal of the foreign body, the previous corneal stromal edema and epithelial microcysts were completely resolved.

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  Fig. 7 Specular microscopy findings before (A) and two weeks after (B) the surgery. Corneal endothelial cell density reduced following the episode of corneal edema, but the percentage of hexagonal cells improved from 35% to 44% after removal of the foreign body. APEX = apex; AVE = average; MAX = maximum; MIN = minimum; NUM = number; CD = cell density; SD = standard deviation; CV = coefficient of variation; 6A = hexagonality.

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