Diagnostic methods in ocular argyrosis: case report

Abstract

PurposeThe aim of this report is to present a case of a patient, metal foundry worker, who had been exposed to industrial silver salts for over 20 years. It is well established that chronic exposure to silver compounds can cause accumulation of silver deposits in various tissues. This condition is referred to as argyrosis or argyria, whereas changes related to eye tissues are defined as ocular argyrosis.MethodsA complete eye examination, corneal confocal microscopy, kinetic and static visual field test, posterior segment optical coherent tomography, pattern visual evoked potentials (PVEP), flash visual evoked potentials, multifocal electroretinogram, pattern electroretinogram (PERG), full-field electroretinography (FERG) and electrooculogram were all performed.ResultsEye examination revealed decreased visual acuity, corneal deposits and drusenoid changes within the macula. Although electrophysiology tests did not show changes in the function of retinal pigment epithelium, they revealed abnormal function of photoreceptors in the central and peripheral retina. PERG abnormalities and delayed latency of P100 wave in PVEP confirmed impaired function of the inner layers of the retina in the macular region.ConclusionsCorneal confocal microscopy and electrophysiological tests may help confirm the diagnosis of ocular argyrosis.

Multimodal ocular imaging in diagnosis and management of occupational ocular argyrosis

“…OA is a rare disorder associated with the deposition of silver in various parts of the eyeball such as eyelids, tears, conjunctiva, lacrimal sac, cornea, lens, ciliary body, and Bruch's membrane [ Table 2 ]. [ 1 2 3 4 7 8 9 10 ] These deposits can be either asymptomatic or lead to cosmetically disturbing skin discoloration, and nyctalopia (from photoreceptor dysfunction). Rarely, DOV from corneal involvement or senile cataract can also occur.…”

Clinical and Forensic Aspects of the Different Subtypes of Argyria

“…Patients with OA have reported visual symptoms, most commonly nyctalopia [ 54 ], and presented with concomitant comorbidities, such as glaucoma [ 151 , 163 ], cataract [ 114 , 149 , 218 , 262 ], diabetic retinopathy [ 111 ], as well as posterior eye segment changes somewhat coherent with the functional complaints [ 157 , 158 ], but without direct link to the silver deposition itself [ 156 , 162 , 263 ]. This inconsistency, alongside several OA patients lacking any visual complaints, has contributed to some consensus regarding the seemingly innocuous silver deposition in the eye, though this claim still needs a more robust foundation [ 21 , 113 , 261 , 263 , 264 ].…”

“…Slit-lamp biomicroscopy is the first step in the diagnostic approach of OA, revealing a particulate pattern in the cornea, but this technique, possibly complemented with confocal microscopy, should be employed for exposure monitoring, or if GA is suspected even without clinical evidence of OA, since cornea’s Descemet’s membrane displays silver deposits quite early following either systemic or local exposition, making slit-lamp examination a sensitive index for both GA and OA [ 102 , 117 , 118 , 120 , 157 , 162 , 199 ]. Other ophthalmological tests have also been reported, such as fluorescein angiography, optical coherence tomography, and electroretinogram, but their purpose so far has been mainly to find eye structural and functional changes related to argyria rather than establishing the diagnosis and with extrapolations limited due to the number and type of studies [ 149 , 156 , 157 , 158 , 218 , 222 ].…”

“…Reports of crystalline lens silver deposits have also been made [54,114,149,155]. In the posterior segment of the eye, silver accumulation is speculated about, following reports of retinal pigment epithelium changes, drusenoid deposits, and dark choroids in fluorescein angiogram, but a necessary causal relationship was not yet clearly established [111,[156][157][158]. Following local contact, silver episcleral and periocular inoculation, such as in the eyelids, can also be present [23,86,[159][160][161]].…”

Clinical Application and Efficacy of Silver Drug in Ophthalmology: A Literature Review and New Formulation of EYE Drops with Drug Silver (I) Complex of Metronidazole with Improved Dosage Form

“…In clinical practice, the diagnosis of eye argyrosis may not be easy due to the rarity of this disease. Differential diagnosis should include other keratopathies (e.g., pre-Descemet dystrophy and X-linked ichthyosis) as well as other causes of abnormal eye pigmentation, such as malignant melanomas, deposition of heavy metals (iron and copper) or drugs (ciprofloxacin and amiodarone) [ 44 , 45 ].…”