A Cloud in the Eye

A 60-year-old male underwent pars plana vitrectomy with silicone oil (SO) injection in the right eye (RE) for tractional retinal detachment due to proliferative diabetic retinopathy (PDR). He was lost to follow-up and presented 2 years later with only perception of light and inaccurate projection of rays. Intraocular pressure (IOP) was 34 mm Hg in the RE. Slit-lamp examination showed emulsified SO (hyperoleon) occupying about 80% of the anterior chamber, obscuring the pupil and posterior segment [Figure 1].Figure 1: Anterior segment image showing 80% of anterior chamber filled with hyperoleon obscuring the underlying structuresSO-induced glaucoma occurs in 2.2% to 56% of cases. Emulsified SO droplets can obstruct the trabecular meshwork, raising IOP. The recommended SO removal window is 3 to 6 months post-op; delays can lead to irreversible damage and secondary glaucoma. SO can also exert a direct toxic effect on the optic nerve head, beginning as early as 1 month after injection.[1] SO can penetrate deep into the optic nerve and may cause granulomatous inflammation in the retrolaminar region of optic nerve[2–4] and, if the oil reaches the optic chiasm, may affect the contralateral optic nerve. This case underscores the need for timely follow-up and early SO removal to prevent sight-threatening complications. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.