Eyelids & the Anterior Segment:
                  Case twenty four

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This 35 year-old man had had a left intraocular foreign body removed from the posterior segment two months earlier. This is his left eye appearance when seen in the clinic.

a. What does the picture show?

The picture shows a repaired corneal perforation, distorted pupil due to iris trauma, inferior iridectomy (Ando's iridectomy) and hyperoleon.

Silicone oil is used as an internal tamponade in this patient due to a giant retinal tear. In an aphakic eye (the patient's lens was removed ), an inferior iridectomy is performed to prevent the silicone oil causing pupillary block glaucoma. The hyperoleon is due to suspension of emulsified silicone oil in the anterior chamber giving an appearance of inverted 'hypopyon'.

b. What complications can develop with the above anterior chamber appearance?

Silicone oil is potentially toxic. Its presence in the anterior chamber can lead to:

• cataract formation
• pupillary block glaucoma
• secondary open angle glaucoma due to blockage fo the trabecular meshwork
• band keratopathy
• corneal decompensation due to endothelium damage

c. How would you manage the problems in b.?

Removal of the silicone oil is the definitive treatment.