Ocular argyrosis: A case with silver deposits in cornea and lens

Clinical and Forensic Aspects of the Different Subtypes of Argyria

“…In the eye, silver deposits exhibit a clear predilection for corneal Descemet’s membrane, but it can also be found in Bowman’s membrane, the stromal tissue in-between, both bulbar and palpebral conjunctiva and the lacrimal caruncle [ 25 , 58 , 102 , 113 , 149 , 150 , 151 , 152 ]. When the lacrimal sac is visualized (following dacryocystectomy), it often displays the pigmentation as well and in a striking fashion, with a strong black tone [ 114 , 153 , 154 ].…”

“…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 ].…”

“…When the lacrimal sac is visualized (following dacryocystectomy), it often displays the pigmentation as well and in a striking fashion, with a strong black tone [114,153,154]. 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].…”