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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 1  |  Issue : 4  |  Page : 707-708

Siderotic cataract without an intralenticular foreign body


1 Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Date of Submission05-Jan-2021
Date of Acceptance15-Mar-2021
Date of Web Publication09-Oct-2021

Correspondence Address:
Dr. Jagat Ram
Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_51_21

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  Abstract 


Among foreign bodies involved in ocular trauma, three-fourths are accounted by iron, causing ocular siderosis. We report a case of total white cataract with golden-brown deposits over the anterior lens capsule. Clinical examination made us suspicious about a foreign body which was detected on a computerized tomography (CT) scan in the ciliary body. The patient underwent cataract surgery, and the anterior capsule was histopathologically proven to have siderotic changes. Caution is advised in cases when there may be a long time interval for the development of ocular siderosis. Siderotic changes in the lens may occur even when there is no intralenticular foreign body.

Keywords: Foreign body, iron, siderotic cataract


How to cite this article:
Behera R, Kaur S, Rastogi P, Sharma V, Ram J. Siderotic cataract without an intralenticular foreign body. Indian J Ophthalmol Case Rep 2021;1:707-8

How to cite this URL:
Behera R, Kaur S, Rastogi P, Sharma V, Ram J. Siderotic cataract without an intralenticular foreign body. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Oct 26];1:707-8. Available from: https://www.ijoreports.in/text.asp?2021/1/4/707/327645



One of the most common reactive foreign body injuries in the eye is caused by iron, mostly occurring as an occupational hazard.[1] A retained iron foreign body results in a myriad of presentations known as ocular siderosis.[1],[2] Siderotic manifestations include retinal pigmentation, optic atrophy, iris heterochromia, mydriasis, secondary glaucoma, and brownish deposits in the corneal stroma, anterior lens capsule, and subcapsular area.[2],[3] We report an interesting case of a middle-aged male, presenting to us with a traumatic white cataract which was histopathologically proven to be siderotic cataract.


  Case Report Top


A 37-year-old male presented to a tertiary care center with progressive diminution of vision in the right eye for the past 6 months. The patient, electrician by profession, did give a history of trauma to the right eye at his workplace 2 years back. He was prescribed some topical medications and painkillers, which alleviated his symptoms. X-ray of the orbit was done at that time, which according to the patient was normal. The patient remained asymptomatic until 6 months ago when blurring of vision started. He consulted a local ophthalmologist again, and a diagnosis of cataract was made. He was referred to us for surgery. At presentation to us, his visual acuity was counting fingers OD. There was a relative afferent pupillary defect in the right eye and intraocular pressure was normal. On slit-lamp examination, the right eye showed a dense white cataract with brownish golden deposits over the anterior lens capsule [Figure 1]a and [Figure 1]b. The anterior chamber was quiet. No intraocular foreign body was seen on slit lamp examination and on gonioscopy. Left eye examination was unremarkable. On ultrasound B-scan, there was no evidence of any retained intraocular foreign body or retinal detachment. However, due to strong clinical suspicion, a CT scan of the orbit was done which revealed a foreign body in the anterior vitreous near the ciliary body [Figure 2].
Figure 1: (a and b) Diffuse and slit view of the anterior segment showing dense white cataract with golden-brown deposits over the anterior lens capsule

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Figure 2: Axial CT scan showing a hyperdense focus 1 × 2 mm in size in the anterior aspect of the right eye (yellow arrow)

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The patient was planned for right eye cataract surgery. The patient underwent right eye phacoemulsification with posterior chamber intraocular lens implantation (IOL) under topical anesthesia. There was no evidence of intralenticular foreign body. The anterior capsule was retrieved during the surgery and sent for histopathological analysis. It showed features of siderotic cataract in the form of extensive deposition of hemosiderin pigment causing disruption of the normal lens cortex [Figure 3]. Postoperatively at 6 weeks, the patient has a stable IOL in the capsular bag, with the best corrected visual acuity of 6/9. Surgery for the removal of the foreign body is subsequently planned.
Figure 3: (a) Histopathology of the lens showing the lens capsule (LC) and cortex (C). The iron pigment deposition in the form of coarse golden-brown granules is seen in the cortex, causing its disruption. (b) Perls' stain highlighting blue colored hemosiderin deposition in the cortex

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  Discussion Top


Foreign body injury in the eye by iron is quite common. The hydroxyl ions produced during the Fenton reaction when iron reacts with ocular tissues cause ocular siderosis.[1],[2] The time interval between the actual injury and development of ocular siderosis varies widely depending upon the size, shape, iron content, and duration it remains within the eye, with presentation as early as 2 months to 18 years after history of trauma[3],[4],[5] at later stages when there is an actual decrease in vision.[6] The earliest indication of siderosis may be the formation of cataract with associated intralenticular foreign bodies. Foreign bodies may be missed on imaging modalities and the development of certain features like siderotic cataract may prompt us to review our diagnosis and use better imaging modalities.[6] In our case, the foreign body was missed initially on X-ray and delineated by CT scan. There were siderotic capsular changes despite there being no intralenticular foreign body.


  Conclusion Top


This case highlights the importance of close follow-up of patients with a history of trauma to the eye. Certain clinical features, even in an asymptomatic patient, should prompt us to review our diagnosis and intervene accordingly. Relevant radiological investigations and clinical documentation in such cases are extremely helpful.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kuhn F, Morris R, Posterior segment intraocular foreign bodies: Management in the vitrectomy era. Ophthalmology 2000;107:821-2.  Back to cited text no. 1
    
2.
MB T, Mutha V, Ravani R, KumarA, Surve A. Retained Intraocular Foreign body. In: Kumar A. Retina Medical and Surgical Management. New Delhi, India: Jaypee Brothers Medical Publishers (P) Ltd; 2018. P 637-42.  Back to cited text no. 2
    
3.
Cazabon S, Dabbs TR, Intralenticular metallic foreign body. J Cataract Refract Surg 2002;28:2233-4.  Back to cited text no. 3
    
4.
Arora R, Sanga L, Kumar M, Taneja M. Intralenticular foreign bodies: Report of eight cases and review of management. Indian J Ophthalmol 2000;48:119-22.  Back to cited text no. 4
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5.
Wu TT, Kung YH, Sheu SJ, Yang CA. Lens siderosis resulting from a tiny missed intralenticular foreign body. J Chin Med Assoc 2009;72:42-4.  Back to cited text no. 5
    
6.
O'Duffy D, Salmon J. Siderosis bulbi resulting from an intralenticular foreign body. Am J Ophthalmol 1999;127:218-9.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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