Citation

Comacchio F, Ricca M, Martini G, Cecchin V, Zannin ME. Oman J. Ophthalmol. 2018; 11(1): 55-57.

Affiliation

Department of Pediatrics, Pediatric Ocular Immunology Unit, University of Padova, Padova, Italy.

Copyright

(Copyright © 2018, Oman Ophthalmic Society, Publisher Medknow Publications)

DOI

10.4103/ojo.OJO_209_2016

PMID

29563698

PMCID

PMC5848351

Abstract

A 14-year-old male teen presented with unilateral episcleritis, unresponsive to topical and systemic corticosteroid therapy, without a history of ocular trauma or evidence for systemic diseases. The presence of foreign bodies in the conjunctival mucus of the hyperemic fornix has been noticed during one of the follow-up examinations. The toxicological analysis of conjunctival mucus revealed the presence of ethylene glycolmonomethyl ether and triethilene glicolebuthyl ether, used as solvents in nail polish removers and all-purpose cleaners. An unexpected etiology of chemical self-inflicted episcleritis was determined. The teen was admitted to a psychological assessment, after which a psychotherapeutic treatment was recommended. Episcleritis is characterized by the acute onset of ocular pain and redness, with a frequent recurrent and stressful course. Since it can be associated with life-threatening systemic vasculitides, a prompt, aggressive immunosuppressive therapy may be considered, both for the ocular inflammation and for the underlying systemic condition. Rarely episcleritis does not improve despite topical and systemic therapy, administered in a stepladder way. The reported teenager case needed a complex multidisciplinary approach to achieve the correct diagnosis and to avoid unnecessary treatments. In the case of recognized "nonsuicidal self-injury," a psychological evaluation is strongly recommended, to identify and address underlying neuropsychiatric problems.

Language: en

Keywords

Adolescence; anterior scleritis; episcleritis; nonsuicidal self-injury; self-induced ocular lesion