Lens Siderosis Resulting from a Tiny Missed Intralenticular Foreign Body

Abstract

We report a patient with clinical ocular siderosis at the time of presentation but undetectable intraocular foreign body on computed tomography (CT) and ultrasonography. A 24-year-old man suffered from right ocular injury when hammering metal on metal. Slit-lamp examination revealed a small corneal perforating wound and an iris hole, but no intraocular foreign body was found under fundus examination. There was also no evidence of intraocular foreign body on ultrasonography and orbital CT scan. About 1 month later, lens siderosis with cataract formation developed, and the patient received lens extraction with intraocular lens implantation. During the operation, a small (< 1 x 1 x 1 mm in size) intralenticular foreign body of metal material was found and removed. The patient's visual acuity improved from 6/20 to 6/6 on the next day. A patient suspected to have intraocular foreign body should be followed-up closely; it is better to remove the foreign body before siderosis bulbi occurs.

Siderotic cataract with no signs of intraocular foreign body

“…Intralenticular foreign bodies account for about 8%–10% of all intraocular foreign bodies. Cataract formation may be an indicator of early siderosis and has been associated with intralenticular foreign bodies [2, 5, 6]. Although computed tomography is still considered to be the gold standard for detection of an occult foreign body, a small intraocular foreign body may be missed with this technique.…”

“…Clinical findings include iris heterochromia, pupillary mydriasis, iron deposition on the corneal endothelium and anterior lens capsule, cataract formation, lens subluxation, secondary glaucoma, uveitis, and retinal pigment changes or degeneration [3, 4]. Patients usually present with a history of ocular trauma, although some may remain asymptomatic and present only later when their visual acuity has decreased [2, 5]. We report a rare case of histopathologically proven lens siderosis in a young woman with a history of trauma but no signs of retained intraocular foreign body.…”

A case of siderosis bulbi without a radiologically detectable foreign body

“…[2][3][4] Ophthalmic involvement is commonly preceded by a prodromal illness, the acutephase response, which is characterized by transient fever, …”

“…Removal of the foreign body is an adequate therapy. 1 Siderosis bulbi with no radiologically detectable foreign body is rare and has been Wu et al 3 and DeAngelis et al 5 also described radiologically undetectable foreign bodies; but in their cases, metallic IOFBs were detected during intralenticular and epiretinal surgeries, respectively.…”

Vi-2 : Apport De l'ÉLECTROPHYSIOLOGIE Chez l'ADULTE : Exemples

“…Si l'objet métallique est repéré, il doit être rapidement retiré [O'Duffy, Salmon, 1999] : les complications oculaires sont alors mineures. Par contre, si le sujet consulte avec retard, il peut se constituer une cataracte sidérotique [Wu et al, 2009] et des dommages rétiniens irréversibles évoluent même si l'objet métallique est enlevé [Schechner et al, 1990]. Ce sont essentiellement les couches internes de la neurorétine qui présentent un dysfonctionnement [Schechner, et al, 1990], [Imaizumi et al, 2000].…”