Chestnut burrs, the thorny encapsulation of chestnut fruit, can sometimes cause
corneal injuries and ulceration, with poor prognoses. We report a case of
corneal perforation and damaged anterior lens
capsule due to a chestnut burr, using anterior segment optical coherence tomography (AS-OCT). A 67-year-old woman with a chestnut burr injury in her right eye was referred to our hospital. Her right best-corrected visual acuity (BCVA) was 0.8.
Slit-lamp examination and AS-OCT showed perforation involving the endothelial layer at the center of the cornea. The iris and anterior lens
capsule were damaged. Cell infiltration was observed around the
wound. Bacterial examination showed gram-positive cocci but no fungi. The patient was diagnosed with a
corneal perforation and bacterial
keratitis.
Levofloxacin 1.5% and
cefmenoxime treatments were initiated and a
soft contact lens was placed to seal the
wound. On day 3, there was no improvement in the corneal cell infiltration, but AS-OCT suggested that the inner
wound had closed. A culture test revealed the presence of Propionibacterium acnes, which was sensitive to both
levofloxacin and
cefmenoxime. Therefore, we continued the same
antibiotic treatment. On day 26, the opacification and cell infiltration at the center of the cornea had improved. AS-OCT showed healing of the corneal
wound with reduction in the central corneal thickness. Her BCVA improved to 1.0. AS-OCT was a valuable tool to noninvasively observe
wound shape and detect the presence of any intracorneal
foreign bodies.