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| PHOTO ESSAY |
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| Year : 2021 | Volume
: 59
| Issue : 4 | Page : 409-410 |
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Traumatic silicone oil herniation masquerading as polypseudophakia
Prateek Jain, Anshuman Pattnaik
Department of Community Medicine, Global Hospital Institute of Ophthalmology, Sirohi, Rajasthan, India
| Date of Submission | 13-Apr-2021 |
| Date of Decision | 27-Jun-2021 |
| Date of Acceptance | 24-Jul-2021 |
| Date of Web Publication | 21-Dec-2021 |
Correspondence Address:
Dr. Prateek Jain
Global Hospital Institute of Ophthalmology, Abu Road, Sirohi - 307 510, Rajasthan
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/tjosr.tjosr_42_21
Ocular trauma is among the common causes of dislocation of lens. An eleven year old male child having history of getting operated on his right eye for congenital cataract with implantation of intraocular lens as well as for subsequent retinal detachment in later phase of life, presented with complains of decreasing vision and pain in right eye after having encountered a blunt trauma. Alongside an anteriorly dislocated IOL and herniated silicone oil bolus in the anterior chamber gave the appearance of a polypseudophakia. Complete clinical examination along with a detailed history is the way for avoiding gross clinical misdiagnosis and thus employing appropriate management.
Keywords: Hyperleon, inverse hypopyon, silicone oil, trauma
How to cite this article:
Jain P, Pattnaik A. Traumatic silicone oil herniation masquerading as polypseudophakia. TNOA J Ophthalmic Sci Res 2021;59:409-10 |
An 11-year-old male child presented with complaints of ocular pain and gradual diminution of vision in the right eye (RE) for 2 months. His father revealed a history of blunt trauma by sibling's fist while playing 2 months back.
Best-corrected visual acuity (BCVA) in RE was 20/400. At first glance, on slit-lamp examination, anterior chamber (AC) in RE appeared accommodating two intra-ocular lens (IOL) optics, one over another resembling dislocated piggyback IOL [Figure 1]. After retracting the upper lid, emulsified silicone-oil droplets were found deposited superiorly in AC. This led to the diagnosis of a herniated silicone-oil bolus lying in front of IOL optic. IOL might have dislocated into AC due to trauma along with herniation of oil from the posterior segment [Figure 2]. B-scan confirmed silicone-oil filled vitreous cavity. IOP was 34 mmHg on applanation tonometry. Fundoscopy revealed silicone-oil-filled vitreous cavity, well-attached retina, and CDR of 0.7:1 indicating glaucomatous optic disc damage. Left eye examination showed BCVA 20/20, well-placed IOL in the capsular bag, and unremarkable posterior segment. | Figure 1: Slit-lamp image giving a false appearance of piggyback intra-ocular lenss dislocated into anterior chamber of the right eye
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 | Figure 2: Slit-lamp image after upper lid retraction showing the presence of emulsified droplets superiorly in anterior chamber confirming silicone oil bolus lying anterior to dislocated intra-ocular lens
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This child was started on antiglaucoma medication to reduce IOP and advised for silicone oil removal and IOL explantation with scleral-fixated IOL implantation.
The patient's old record revealed congenital cataracts in both eyes which were extracted followed by IOL implantation. The patient later had rhegmatogenous retinal detachment in RE for which vitreoretinal surgery was done and silicone oil was injected 1 year back elsewhere. He was advised for silicone oil removal to which he did not comply.
This is a case of “reverse-hypopyon” or “hyperleon.” It can develop when silicone oil used during vitreoretinal surgery if not removed on time gets emulsified and enters into AC. It blocks the trabecular meshwork leading to a rise in IOP. Long-standing raised IOP damaged optic nerve. Silicone oil being lighter than aqueous humor appears like a layered hypopyon in the superior quadrant of AC.[1],[2] The aim of silicone oil use as a vitreous substitute is to provide tamponade to a detached retina.
A major drawback of silicone oil is its tendency to emulsify. Emulsification means formation of oil droplets at the interface between oil-bubble and intraocular fluid. It leads to dispersion of these droplets into aqueous and vitreous humor with a consequently higher risk of proliferative vitreoretinopathy, retinal re-detachment, inflammation, secondary glaucoma, and keratopathy.[3]
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Acknowledgments
The authors acknowledge the guidance of Dr. V C Bhatnagar, Head of Department and Medical Superintendent, Global Hospital Institute of Ophthalmology.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Tripathy K, Sharma YR. Inverted hypopyon in the eye. BMJ Case Rep 2016;2016:bcr2016214638.  |
| 2. | Yiu G, Emami-Naeni P. Inverted hypopyon. JAMA Ophthalmol 2019;137:e185256. |
| 3. | Federman JL, Schubert HD. Complications associated with the use of silicone oil in 150 eyes after retina-vitreous surgery. Ophthalmology 1988;95:870-6. |
[Figure 1], [Figure 2]
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