Photo Quiz

Eye Pain in a Contractor Working in Iraq

 

Am Fam Physician. 2017 Mar 15;95(6):389-390.

A civilian contractor working in Iraq presented with two days of unilateral eye pain and redness. The symptoms began after a cloud of dust blew into his face while fixing an old generator. He was wearing safety glasses but not goggles. Initially, he had mild bilateral eye irritation and rinsed his eyes with water, but his eyes became red with increasing pain in the right eye. He tried over-the-counter eye drops without relief. His medical history was significant for hypertension. He had no history of vision changes, previous eye injury, or contact lens use.

On physical examination, his vital signs were normal. Visual acuity was 20/40 for the left eye, right eye, and both eyes together. Eye examination revealed temporal and inferior conjunctival injection of the right eye. There was a 1.5-mm, brownish, circular lesion along the iris (Figure 1). The patient reported pain with eye movement when his eyes were closed. There were no foreign bodies or lesions on the underside of the eyelid, and his left eye appeared normal. His pupils were equal, round, and reactive to light bilaterally.

Fluorescein staining of the right eye demonstrated circumferential uptake around the lesion with punctate uptake across the inferior conjunctiva. There was no evidence of an ocular leak. Slit-lamp examination was negative for cells within the anterior chamber. A cotton-tipped applicator was used to remove a 1-mm, black, irregularly shaped foreign body.


Figure 1.

Question

Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Bitot spot.

B. Corneal rust ring.

C. Herpetic keratitis.

D. Hyphema.

E. Perforation of

Address correspondence to Catherine Gill, MD, at catherine.a.gill4.mil@mail.mil. Reprints are not available from the author.

Author disclosure: No relevant financial affiliations.

REFERENCES

show all references

1. Zuckerman BD, Lieberman TW. Corneal rust ring: etiology and histology. Arch Ophthalmol. 1960;63:254–265....

2. Langston DP. Manual of Ocular Diagnosis and Therapy. 6th ed. Philadelphia, Pa.: Lippincott Williams & Wilkins; 2008.

3. Gerstenblith AT, Rabinowitz MP. The Wills Eye Manual: Office and Emergency Room Treatment of Eye Disease. 6th ed. Philadelphia, Pa.: Lippincott Williams & Wilkins; 2012.

4. Gilbert C. The eye signs of vitamin A deficiency. Community Eye Health. 2013;26(84):66–67.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor.

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