PMC9899018_01
Slit lamp photographs of six cases of corneal perforation at presentation to our hospital. (A) Left eye of Case 1: Peripheral perforation is observed on the inferior nasal side with disappearance of the anterior chamber and iris depression. (B) Left eye of Case 2: Peripheral perforation on the superior nasal side with iris depression and disappearance of the anterior chamber. (C) Right eye of Case 3: Inferior temporal peripheral perforation with iris depression. (D) Left eye of Case 4: Temporal paracentral perforation with iris depression and disappearance of the anterior chamber. (E) Right eye of Case 5: Inferior temporal paracentral perforation with iris depression and disappearance of the anterior chamber. In addition, blood vessels invading a part of the cornea are observed. (F) Left eye of Case 5: Temporal paracentral perforation with iris depression and vascular invasion into the cornea and corneal opacity. (G) Left eye of Case 6: Inferior nasal paracentral perforation with iris depression and disappearance of the anterior chamber. (H) Same eye as in (G): Concretions in the lacrimal canaliculi are visible through the punctum (black arrow).
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At presentation, slit-lamp examination of the left eye revealed paracentral corneal perforation on the lower nasal side with abundant discharge, and the anterior chamber was absent due to leakage of aqueous humor from the perforated cornea (Figure 1G). Concretions were observed in the left lower punctum (Figure 1H).
Photograph of extraction of concretion and Histopathological micrograph of the extracted concretion. PAS staining reveals thin filamentous masses over a wide area, suggesting the presence of Actinomyces.
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Pathological examination of the concretion revealed small aggregates of Gram-positive cocci and filamentous bodies by Gram staining, and filamentous bodies over a wide area by PAS and Grocott staining (Figure 2).