Delhi Journal of Ophthalmology

Acute Foreign Body Reaction And Corneal Abrasion Secondary To Impacted Human Hair In Tarsus

Atif Rahman Raini
Al Rahman Eye Hospital, Balrampur, Uttar Pradesh, India

Corresponding Author:

Atif Rahman Raini
Al Rahman Eye Hospital, Balrampur, Utter Pardesh, India
E-mail: atifraini1985@gmail.com

Received: 08-JAN-2020

Accepted: 03-MAY-2020

Published Online: 12-MAR-2021

DOI:http://dx.doi.org/10.7869/djo.628

Abstract
Eye injury due to foreign body is the most common cause of ocular emergency. Hair as a foreign body is very much common due to plant, pet’s ad caterpillars. But human hair impacted in tarsus is very rare. Our case is unique as in the way where we found a hair which is probably human in origin and was impacted in the tarsus. We initially missed the hair end but later meticulous high magnification slit lamp examination after eversion of the eyelid, we were able to locate the hair end as tiny black spot. This indicate the importance of eversion of the upper eyelid and slit lamp examination in higher magnification.

Keywords :Corneal abrasion, human hair, slit lamp examination, eversion of the eyelid, ophthalmia nodosa (ON)

Introduction
A number of cases of hairs of plants and of certain insects notably caterpillars burrowing into the tissues of the conjunctiva and setting up a condition resembling ophthalmia nodosa or subacute trachoma are recorded.1,2 Human hair as foreign body in  the conjunctiva has been reported in the past by Sathe SM.3 Corneal abrasion due to foreign body impacted in the conjunctiva is very common.  Our case is unique in the way that acute foreign body reaction was due to human hair which got impacted in the tarsus. We initially missed the hair end but later meticulous high magnification slit lamp examination after eversion of the eyelid, we were able to locate the hair end as tiny black spot. This indicate the importance of eversion of the upper eyelid and slit lamp examination in higher magnification.

Case History
An eighteen year male patient presented with the chief complaint of watering, redness and irritation in the left eye from 2 days. Patient gave history that something fell into the eye while he was riding bike and he rubbed his eyes after that.
On examination patients visual acuity (VA) in the right eye was 6/6 and in the left eye it was 6/12p. slit lamp examination of the  right eye was normal but in left eye bulbar and palpebral conjunctiva  were congested. Cornea had linear abrasion mark all over surface, which on staining looked like linear criss cross lines all over the corneal surface (Figure 1). Initially no foreign body was found on eversion of the eyelid but the staining of cornea was suggestive of some foreign body rubbing the cornea. Further careful examination and meticulous search in the higher magnification, we found a black spot in the palpebral conjunctiva which appeared as impacted hair in the tarsus (Figure 2). This was suggestive of type 2 ophthalmia nodosa characterised by chronic keratoconjunctivitis due to impacted hair in the bulbar or palpebral conjunctiva.4


Figures 1: fluorescein staining of cornea


Figure 2:  Impacted hair in the tarsus

After instilling paracaine 0.5%, we were not able to remove the foreign body initially and furthermore when we tried to catch the hair it vanished from the site. But when pressure was applied beside that spot, it came out. Later patch was applied with Moxifloxacin 0.5% w/w ointment and Hydroxpropyl Metylcellulose 2% ocular lubricating gel. Hair was examined under the microscope (Figure 3). It did not appeared to be barbed, it had smooth outer surface  and  appeared to be a human hair (shape of hair goes in favour of human hair). Since human hair can only be recognised with a histopathoogical examination which we do not have in our clinic, it could not be confirmed unequivocally that it was nothing but human hair.
Patient reviewed next day, he was happy with visual acuity of 6/6 and decrease in congestion, irritation and watering with no fluorescein staining.


Figure 3: removed hair on light microscopy

Discussion
Eye injuries from foreign bodies remain one of the common presentations to the emergency department. In this case we found an impacted hair in the tarsus probably human in origin (smooth surface and shape on  microscopy). Since human hair do not have any setae so it can not penetrate deep in the tarsus but in this case on light microscopy we did not find barb or setae, it had smooth outer surface which probably confirms it to be of human origin. Human hair as foreign body in the conjunctiva has been reported in the past by Sathe SM.(3) When a male aged 40 years presented with  complain of photophobia, lacrimation and pain in the right eye for the last 2 months presented with positive history of hair cut few days back. On Slit Lamp examination of the everted right upper lid they found raised areas (follicles) eight in number. The centre of each area was marked by a tiny black spot which looked like the end of a hair. After pulling out one of the hairs which was lying embedded in the follicle, they examined it under a microscope. It did not appear to be barbed and it appeared to be a human hair. Next day the whole strip of tarsus was removed and preserved as a specimen.

Conclusion
Sometimes foreign body may be missed on initial examination. So in every case of suspected foreign body, a meticulous slit lamp examination in higher magnification must be done with double eversion of lid. When a patient complains of foreign-body sensation, topical fluorescein should be instilled to check for the fine, linear, vertical corneal abrasions that are characteristic of retained foreign bodies on the eyelid margins or superior tarsal plate.

References
  1. Sengupta S, Reddy PR, Gyatsho J, Ravindran RD, Thiruvengadakrishnan K,Vikram V. Risk factors for intraocular penetration of caterpillar hair in ophthalmia nodosa: a retrospective analysis. Indian J Ophthalmol 2010;58:540–543. 
  2. Cadera W, Pachtman MA, Fountain JA, Ellis FD, Wilson FM. Ocular lesions caused by caterpillar hairs (ophthalmia nodosa). Can J Ophthalmol. 1984;19:40–44. 
  3. Sathe S M. Hair as foreign bodies in the conjunctiva.Indian J Ophthalmol. 1956;4:43-44.
  4. Cadera W, Pachtman MA, Fountain JA, Ellis FD, Wilson FM., 2nd Ocular lesions caused by caterpillar hairs. Can J Ophthalmol. 1984;19:40–4.

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Raini ARAcute Foreign Body Reaction And Corneal Abrasion Secondary To Impacted Human Hair In Tarsus.DJO 2021;31:67-68

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Raini ARAcute Foreign Body Reaction And Corneal Abrasion Secondary To Impacted Human Hair In Tarsus.DJO [serial online] 2021[cited 2021 Apr 21];31:67-68. Available from: https://www.djo.org.in/articles/31/3/Acute-Foreign-Body-Reaction-And-Corneal-Abrasion-Secondary-To-Impacted-Human-Hair-In-Tarsus.html