Case Reports

Ocular siderosis: a case report

Case Report Details

First Author: T.Bouzoubaa MOROCCO

Co Author(s):    B. Tamym   E. Abdallah   A. Berraho              

Abstract Details

Purpose:

Siderosis is the inevitable complication of any metallic intra-ocular foreign body left in place or remains unrecognized. The toxicity will be more important as the foreign body is particularly concentrated in iron. Even after appropriate treatment, the irreversibility of the lesions is quite frequent, the functional prognosis is linked to the location and the time taken for treatment. The report is essentially preventive. We report a case of ocular siderosis revealed by a post-traumatic siderotic cataract by a neglected piece of iron.

Setting:

This is a 9year old boy seen in the emergency for a gradual decrease in visual acuity in his left eye, the examination does not reveal any particular history, the beginning symptoms go back 8 months with a progressive decrease in visual acuity the left eye following an eye trauma.

Report of Case:

The ophthalmological examination shows positive light perception without correction, a corneal pillowcase at 5 o'clock with an Irish pertuis in re-gard of the pillowcase, a total cataract with a brown coloring pulling on the rust, the ocular tone at 14mmhg and the fundus was unenlightable. Examination of the contralateral eye was normal The face and profile orbit radiography and the cerebral orbito CT scan, which are in favor of an intra-ocular foreign body. The ocular echography of the left eye shows no retinal detachment, the axial length is 23.4mm, discreetly heterogeneous vitreous and fine choroid. The paraclinical examination was completed by the flash ERG which was normal at the DO level, and of amplitude greatly reduced at the DO level whatever the stimulation mode, PEV altered. The patient benefited from a cataract surgery which consists of a phacophagy with an anterior vitrectomy and placement of an implant, the foreign body was removed by the electromagnet, the evolution was marked by a recovery. visual acuity 1/10 after one month and 5/10 after 6 months, the fundus was normal. Ocular siderosis is caused by the oxidation of iron, which causes a toxic dispersion of ferrous ions in the retinal cells, mainly due to damage to photo-receptors and the pigment epithelium. Iron is deposited in the epithelial tissues at the level of the iris, the ciliary body, the lens and the retina.

Conclusion/Take Home Message:

The clinical picture of ocular siderosis includes: progressive degeneration of the cornea with deep paralimbic ring of rust, heterochromia iris, mydriasis, clouding of the lens with the presence of small rust spots on or under the anterior capsule, impregnation of the zonular fibers weakens the lens capsule, making possible cataract extraction more risky.an inflammatory reaction develops and it is responsible for chronic uveitis, pigmented deposits disperse at the level of the trabecular meshwork, causing ocular hypertonia. The vitreous is colored and charged with brownish particles with a vitreous reshuffle, At the posterior pole there is a retinal pigmentary degeneration with impaired night vision The foreign body must be removed as soon as possible, their excision is a relatively simple surgical procedure which must be done in time before installation complications. Any eye trauma must be the subject of an immediate radiological examination and prompt treatment so that we avoid complication.

Financial Disclosure:

None