Hao Wu, Xiaoqing Chen, Dan Liang
This case underscores that occult IOFBs should be considered in the differential diagnosis of recalcitrant unilateral uveitis, even when systemic associations are present. Careful re-examination after inflammation subsides and the appropriate use of imaging modalities like UBM are essential to prevent diagnostic delays and preserve vision.
INTRODUCTION: Intraocular foreign bodies (IOFBs) can induce recurrent uveitis and may be easily overlooked when a plausible systemic etiology, such as HLA-B27 positivity, is present. This report documents a diagnostic challenge where an occult eyelash masqueraded as HLA-B27-associated disease.
CASE PRESENTATION: A 13-year-old female with HLA-B27 positivity presented with four episodes of recurrent unilateral anterior uveitis, initially diagnosed and treated as HLA-B27-associated uveitis. Following the resolution of active inflammation with medical therapy, a subtle iris protuberance was identified at the 5 o'clock position. Ultrasound biomicroscopy (UBM) confirmed a hyper-reflective foreign body embedded in the angle recess. Following successful surgical removal of an eyelash, the inflammation resolved rapidly with no recurrence over a 2-year follow-up period.
CONCLUSION: This case underscores that occult IOFBs should be considered in the differential diagnosis of recalcitrant unilateral uveitis, even when systemic associations are present. Careful re-examination after inflammation subsides and the appropriate use of imaging modalities like UBM are essential to prevent diagnostic delays and preserve vision.