An Occult Intraocular Eyelash Masquerading as Chronic Recurrent Uveitis: A Case Report

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 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.