Kayser-Fleischer Ring and Sunflower Cataract in Wilson Disease

Several heavy metals and other chemical elements are natural components of the Earth’s crust and their properties and toxicity have been recognized for thousands of years. Moreover, their use in industries presents a major source of environmental and occupational pollution. Therefore, this ubiquity in daily life may result in several potential exposures coming from natural sources (e.g., through food and water contamination), industrial processes, and commercial products, among others. The toxicity of most chemical elements of the periodic table accrues from their highly reactive nature, resulting in the formation of complexes with intracellular compounds that impair cellular pathways, leading to dysfunction, necrosis, and apoptosis. Nervous, gastrointestinal, hematopoietic, renal, and dermatological systems are the main targets. This manuscript aims to collect the clinical and forensic signs related to poisoning from heavy metals, such as thallium, lead, copper, mercury, iron, cadmium, and bismuth, as well as other chemical elements such as arsenic, selenium, and fluorine. Furthermore, their main sources of occupational and environmental exposure are highlighted in this review. The importance of rapid recognition is related to the fact that, through a high degree of suspicion, the clinician could rapidly initiate treatment even before the toxicological results are available, which can make a huge difference in these patients’ outcomes.

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“… Sunflower cataracts seen with slit lamp—( A – E ). Reprinted from ( A )—[ 168 ], ( B )—[ 169 ], ( C , D )—[ 170 ], ( E )—[ 171 ]. …”

Section: Coppermentioning

confidence: 99%

Clinical and Forensic Signs Resulting from Exposure to Heavy Metals and Other Chemical Elements of the Periodic Table

Machado

Dinis-Oliveira

2023

JCM

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“…Juvenile/adult onset cataracts are seen in cerebrotendinous xanthomatosis (CTX), associated with progressive neurological abnormalities and tendon xanthomata, and Wilson disease can also present with ‘sunflower cataracts’ as well as the classical Kaiser-Fleischer rings. 23,24…”

Section: Specific Eye Findingsmentioning

confidence: 99%

Eye involvement in inherited metabolic disorders

Davison

2020

Ophthalmol Eye Dis

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Inherited metabolic disorders are a large group of rare disorders affecting normal biochemical pathways. Many metabolic disorders can present with symptoms affecting the eye, and eye disorders can evolve later in the natural history of an already diagnosed metabolic disorder. The ophthalmic involvement can be very varied affecting any part of the eye, including abnormalities of cornea, lens dislocation and cataracts, retina and the distal optic pathway, and extraocular muscles. Awareness of inherited metabolic disorders is important to facilitate early diagnosis and in some cases instigate early treatment if a patient presents with eye involvement suggestive of a metabolic disorder. Ophthalmological interventions are also an important component of the multisystem holistic approach to treating patients with metabolic disorders.

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“…Similarly, sunflower cataract rarely interferes with vision. 5 Both KF rings and sunflower cataracts resolve with adequate chelation of copper. 2,3 Despite having an awareness of these signs, many clinicians may never have actually seen them, and may not note their presence when reviewing a patient having a possible diagnosis of WD.…”

mentioning

confidence: 99%

Kayser–Fleisher Ring and Sunflower Cataract in a Child with Wilson's Disease

Koay

Zahari

Lee

2017

Pediatrics & Neonatology

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Wilson's disease (WD) is characterized by excessive accumulation of copper in the central nervous system, liver, kidneys, cornea, and other organs, leading to damage of the liver and brain. 1 A KaysereFleischer (KF) ring, a brownish coloration of the outer margin of the cornea in the Descemet's membrane, is characteristic of WD. 2 Another rare ophthalmic manifestation of WD is sunflower cataract. 3 Both KF rings and sunflower cataracts are best observed with an ophthalmic microscope. An 8-year-old girl with WD presented with lethargy, abdominal distension, and bilateral edema that had been present for 6 months. On examination, we noted jaundice, abnormal liver enzymes, and prolonged coagulation time. The total and conjugated serum bilirubin levels were 125 mmol/L and 98 mmol/L, respectively. Alanine trans-* Corresponding author.

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Kayser-Fleischer Ring and Sunflower Cataract in Wilson Disease

Cited by 6 publications

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Clinical and Forensic Signs Resulting from Exposure to Heavy Metals and Other Chemical Elements of the Periodic Table

Clinical and Forensic Signs Resulting from Exposure to Heavy Metals and Other Chemical Elements of the Periodic Table

Eye involvement in inherited metabolic disorders

Kayser–Fleisher Ring and Sunflower Cataract in a Child with Wilson's Disease

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