Mysterious case of corneal oedema caused by retained lens fragment

An 89-year-old man experienced multiple episodes of corneal swelling over 18 months with an initial diagnosis of viral keratitis

brown eye
Pixabay/Tobias Dahlberg

An elderly patient experienced multiple episodes of corneal swelling over an 18-month period caused by a retained lens fragment.

Writing in BMJ Case Reports, clinicians described how the 89-year-old man was referred to hospital for treatment following a diagnosis of recurrent herpetic keratitis.

The patient had a history of bilateral phacoemulsification surgeries. On presentation, he reported experiencing soreness and light sensitivity in his left eye for the past 18-months.

Over this time, the patient visited the ophthalmology casualty and outpatient clinic several times and was diagnosed with herpetic keratitis.

An optical coherence tomography scan revealed a hyper-reflective mass, which was a retained lens fragment in the anterior chamber of the left eye.

Following removal of the fragment, the corneal swelling reduced and the patient’s symptoms improved.

The clinicians highlighted that inferior corneal oedema in the eye following cataract surgery should raise suspicion of a retained lens fragment.

“Frequent symptomatic recurrences in the absence of other typical features of anterior segment inflammation should prompt the ophthalmologist to consider another diagnosis than viral keratitis,” they emphasised.