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Heavy metal––not just hard on the ears: siderosis following retained intraocular foreign body

Published:September 26, 2017DOI:https://doi.org/10.1016/j.jcjo.2017.07.001
      Ocular siderosis results from the toxic effects of iron released from retained metallic intraocular foreign bodies (IOFBs).
      • Schechner R.
      • Miller B.
      • Merksamer E.
      • Perlman I.
      A long term follow up of ocular siderosis: quantitative assessment of the electroretinogram.
      Over time, intraocular iron dissociates and deposits in epithelial structures, including the lens, iris, ciliary body, and retina, resulting in degeneration of ocular tissues.
      • Ballantyne J.F.
      Siderosis bulbi.
      A 31-year-old male presented with a 3-month history of diminishing vision OS. The patient reported having had a 2-mm piece of metal removed from his left cornea (after metal-on-metal eye injury) 5 months prior. Since that time, he had noticed progressive ocular irritation, nyctalopia, and decreasing vision OS. Slit-lamp examination revealed a corneal entrance wound near the limbus. Further examination showed iris heterochromia and a prominent cataract OS with rust-coloured pigment on the anterior lens capsule (Fig. 1A–C). Given these classic findings, siderosis secondary to a retained IOFB was suspected. A computed tomography scan of the head was performed and revealed a hyperdensity OS, suggestive of a retained metallic IOFB (Fig. 1D). The patient subsequently underwent successful pars plana vitrectomy, removal of IOFB, and cataract extraction with posterior chamber intraocular lens implantation.
      Fig. 1
      Fig. 1Ocular findings of siderosis: (A) normal iris colouration OD; (B) hyperchromic heterochromia OS; (C) posterior-subcapsular cataract with rust-coloured pigment on the anterior lens capsule; (D) computerized tomography showing hyperdensity, suggestive of retained intraocular foreign body OS.

      Disclosure

      The authors have no proprietary or commercial interest in any materials discussed in this article.

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