Abstract
BackgroundTo report a case of keratitis and a case of conjunctivitis caused by synthetic fibers from toy teddy bears.Case presentationCase stories with histopathological analysis. 1) A two-year-old girl developed a severe case of keratitis and corneal ulceration. The initial treatment with various antibiotics gave no improvement and eventually the patient developed spontaneous perforation of the cornea. The corneal swabs contained no bacteria or fungi. Corneal grafting was performed and the corneal button was sent for histopathological examination. 2) A five-year-old girl presented with ocular irritation in her left eye. Examination revealed a conjunctival granuloma in the inferior fornix. The lesion was excised and histopathologically examined.ResultsMicroscopy revealed synthetic fibers embedded in the cornea and in the conjunctival granuloma. The diagnosis was confirmed by demonstration of marked birefringence of the synthetic fibers. Microscopical examination of synthetic fibers from two different types of fur (whiskers and face hairs) from the two-year-old girl's teddy bear was performed. Hairs from the face of the teddy bear were morphologically and microscopically identical with the fibers causing the severe corneal ulceration in the two-year-old girl.ConclusionsDoctors should especially in small children be aware of the risk of ocular consequences of close exposure of synthetic fibers from stuffed toy animals. Corneal ulceration, clinically presenting as corneal infection with negative culturing and staining, should lead to a different clinical strategy and treatment. The treatment of conjunctival synthetic fiber granuloma is excision and antibiotic eye drops.
Highlights
To report a case of keratitis and a case of conjunctivitis caused by synthetic fibers from toy teddy bears.Case presentation: Case stories with histopathological analysis. 1) A two-year-old girl developed a severe case of keratitis and corneal ulceration
We report a unique case of keratitis and a case of conjunctival granuloma caused by synthetic fibers from toy teddy bears
Increased tear flow, redness and foreign body sensation are the initial symptoms associated with foreign body in the eye, followed by pain, photophobia and ciliary injection
Summary
Case 1 The light microscopy showed a heavily inflamed and ulcerated cornea (Figure 1B). The stroma contained a granulomatous lesion with multiple histiocytes and neutrophils. Numerous round to oval shaped blue and brown fibers with black granular spots were seen centrally in the lesion (Figure 1C). The diameter of the fibers ranged from 20-30 μm and showed strong birefringence in polarized light (Figure 1D). Hairs from the face of the teddy bear were morphologically and microscopically identical with the fibers causing the severe corneal ulceration in the two-year-old girl. Case 2 Microscopical examination of the conjunctiva revealed a normal differentiated conjunctival epithelium with goblet cells (Figure 1E). The subepithelial stroma contained a granuloma with inflammatory cells, mostly eosinophils, histiocytes and foreign body giant cells (Figure 1F). Synthetic fibers, identified by their strong birefringence in polarized light were found within the lesion. We could not identify the chemical composition of these fibers
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