The vitreous samples were sent for broad-range bacterial (16S ribosomal RNA gene sequencing) and fungal (28S ribosomal RNA gene and internal transcribed spacer sequencing) polymerase chain reaction, as well as viral polymerase chain reaction. Foscarnet was also administered intravitreally. The patient was treated empirically for endophthalmitis with vitreous tap and injection of vancomycin and ceftazidime. A focal elevation was noted in the nasal eye wall consistent with an abscess ( Figure 1A). Significant media opacity precluded fundus examination.ī-scan ultrasonography demonstrated vitreous opacities consistent with vitritis. Anterior segment exam of the left eye was significant for a 1.3-mm hypopyon, 4+ cell, and 3+ flare. No scleromalacia was noted in either eye. Slit-lamp examination of the left eye revealed nonblanching scleral injection nasally. The left pupil was minimally reactive with no afferent pupillary defect. Intraocular pressure was normal in the right eye and 6 mmHg in the left eye. He denied a history of ocular trauma or surgery.Įxamination revealed visual acuity of 20/20 in the right eye and hand motions in the left eye. He was not using other medications and denied recreational drug use. The patient's review of systems was positive for osteoarthritis of the wrists and infrequent oral ulcers. He presented with worsening eye pain, headache, and “loss of all vision in the eye.” Multiple interventions by the referring doctor were ineffective, including topical prednisolone acetate, oral ibuprofen, and oral prednisone 80 mg daily. He initially developed sectoral scleritis on the nasal aspect of the eye. Case Reports Case 1Ī 71-year-old man with no past medical or ocular history presented to the emergency department with left eye redness, pain, and vision loss. Our cases and a review of the literature suggest IIC should be included in the differential diagnosis of scleritis, particularly when refractory to anti-inflammatory treatments and associated with progressive intraocular inflammation. We report two cases of IIC that follow a similar pattern of ocular inflammation. Subsequent inoculation of the ocular fluids then results in intraocular inflammation. 3,4,7 We hypothesize that IIC enter the eye by passage through the sclera, resulting in focal scleritis. 2–7 Three of the cases presented with scleritis and signs of endophthalmitis, such as vitritis or hypopyon.
To date, there have been six reported cases of IIC, all of which have been associated with ocular inflammation.
1 Less commonly, idiopathic intraocular cilia (IIC) have been reported in the absence of ocular trauma or surgery. Intraocular cilia have been widely reported in the setting of penetrating eye trauma and after ophthalmic surgery.
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