Severe Self-Inflicted Acute Ocular Siderosis Caused by an Iron Tablet in the Conjunctival Fornix

Abstract

We present the case of a female patient who grinded a ferrous sulfate tablet and placed it at the conjunctival fornix of her left eye. She rapidly developed severe ocular siderosis, with profoundly decreased visual acuity, corneal opacities, cataract, retinal degeneration and ultimately phthisis bulbi. To our knowledge, this is the first report on the consequences of application of an iron tablet on the conjunctiva.

Unilateral Ocular Siderosis Bulbi Due to Missed Metallic Intraocular Foreign Body Masquerading as Anisocoria of Neurological Origin: A Case Report

“…It can present as a cataract in the lenses, glaucoma, iris heterochromia, mydriasis, and retinitis pigmentosa changes. On electroretinogram, the changes of ocular siderosis are an increase in “a” waves followed by a continual reduction of “b” waves [ 1 – 4 ].…”

“…With the availability of advanced vitrectomy techniques, early removal of IOFBs is the preferred treatment modality. Early removal prevents vision-threatening complications like endophthalmitis and siderosis [ 1 – 4 ]. Also, it is important to note that potential complications of the removal procedures still pose a challenge.…”

“…Ocular siderosis is an uncommon cause of vision loss that was first described with the term “siderosis bulbi” [ 3 , 4 ] and results from iron deposition within the ocular tissue from a retained ferrous IOFB. The condition may appear from a few days to many years following injury, and any ocular tissue from the cornea to the optic nerve can be affected.…”

“…The condition may appear from a few days to many years following injury, and any ocular tissue from the cornea to the optic nerve can be affected. The most common manifestations are cataract formation (especially anterior subcapsular), diffuse pigmentary changes of the retinal pigment epithelium, iris heterochromia, often in conjunction with a dilated pupil, secondary glaucoma, iritis, and cystoid macular edema [ 4 ].…”

Ocular siderosis: a misdiagnosed cause of visual loss due to ferrous intraocular foreign bodies—epidemiology, pathogenesis, clinical signs, imaging and available treatment options

“…Wise et al reported that deferoxamine subconjunctival injection (10–100 mg) was able to prevent the development of OS but not to resolve established cases because chelation can only remove free iron ions before becoming stored within cells [ 119 ]. Additionally, topical deferoxamine drops (concentration 10%) showed no clinical improvement [ 121 ]. It is crucial to remark that deferoxamine-related toxicity exists, both systemic (bone dysplasia and high-frequency sensorineural hearing impairment) and topic (RPE alteration, reduction in ERG amplitudes, nyctalopia and colour vision alteration, principally in the tritan axis) [ 122 ].…”