The Swiss Watchmaker’S Eye: A Case Of Limbal Stem Cell Deficiency Due To Repeated Micro-Trauma From A Magnifier Lens

To describe a case of limbal stem cell deficiency in a healthy 47-year-old patient that presented following repeated micro-trauma that occurred from the use of a watchmaker’s monocle loupe.

Department of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland.

A healthy 47-year-old-female patient consulted for redness and pain in her right eye for 2 years. She had been ineffectively treated for dry eye disease during that period with multiple ocular lubricants and vitamin A ointment. Personal history revealed that she is a watchmaker and that she had been using for more than 20 years a monocle loupe magnifier with her right eye.

Visual acuity was 20/20 and intraocular pressure was normal in both eyes. Slit lamp examination of the right eye revealed a conjunctival hyperemia, a neovascular pannus covering the inferior one third of the cornea and a marked superficial puncture keratitis. There were no signs of significant blepharitis or intraocular inflammation. Left eye examination was normal.

The patient was diagnosed with limbal stem cell deficiency in the right eye. Other possible aetiologies such as autoimmune keratitis and herpetic keratitis were excluded by serology tests and localised corneal stromal thinning was excluded using anterior segment OCT.

She was treated with Dexamethasone 0.1% drops (Dexafree, Thea Pharma) four times daily tapered gradually every two weeks and artificial tears (Lacrycon, Thea Pharma) six times daily. At one week and one month follow visits, the patient was asymptomatic, there was no conjunctival hyperemia andan important regression of inferior corneal pannus. The clinical picture continued to improve at six- and nine-months follow-up visits.

In this case of limbal stem cell deficiency, the use of a monocle loupe daily for more than 20 years causing repeated micro-trauma of the inferior ocular surface was identified as a causative agent. The patient, previously misdiagnosed and suffering from symptoms affecting her professional and private life for two years, wasthen effectively treated. This case highlights the importance of personal and occupational history that can be essential in determining the causative agents of refractory disease.