|Year : 2022 | Volume
| Issue : 4 | Page : 939-940
Anterior segment optical coherence tomography features of ocular siderosis in a missed intra-ocular foreign body
Devika Singh1, SP Kruthika2, Devashish Dubey3, Neeraj Shah1
1 Department of Cornea and Refractive Services, Sankara Eye Hospital, Jaipur, Rajasthan, India
2 Department of General Ophthalmology, Sankara Eye Hospital, Jaipur, Rajasthan, India
3 Department of Vitreo Retinal Services, Sankara Eye Hospital, Jaipur, Rajasthan, India
|Date of Submission||18-Apr-2022|
|Date of Acceptance||13-Jul-2022|
|Date of Web Publication||11-Oct-2022|
Dr. Devashish Dubey
Sankara Eye Hospital, Vidyadhar Nagar, Jaipur, Rajasthan - 302 039
Source of Support: None, Conflict of Interest: None
A 40-year-old gentleman with a history of repaired corneal perforation with anterior chamber hyphema was referred to the cornea clinic for suspected blood staining of the cornea. Diffuse corneal ocular siderosis and blood staining can present with a similar clinical picture. We describe the anterior segment optical coherence tomography features in our case which helped us differentiate between these presentations.
Keywords: AS-OCT (anterior segment optical coherence tomography), blood staining, IOFB (intra-ocular foreign body), siderosis
|How to cite this article:|
Singh D, Kruthika S P, Dubey D, Shah N. Anterior segment optical coherence tomography features of ocular siderosis in a missed intra-ocular foreign body. Indian J Ophthalmol Case Rep 2022;2:939-40
|How to cite this URL:|
Singh D, Kruthika S P, Dubey D, Shah N. Anterior segment optical coherence tomography features of ocular siderosis in a missed intra-ocular foreign body. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 Nov 27];2:939-40. Available from: https://www.ijoreports.in/text.asp?2022/2/4/939/358201
Diffuse corneal ocular siderosis and blood staining can present with a similar clinical picture. Existing literature on confocal microscopic features as well as histopathological analysis of corneal siderosis documents features which can help differentiate between the two. We describe the AS-OCT (anterior segment optical coherence tomography) features in our case which helped us differentiate between these presentations.
| Case Report|| |
A 40-year-old gentleman with a history of repaired corneal perforation with anterior chamber hyphema was referred to the cornea clinic for suspected blood staining of the cornea. He had a history of trauma to the left eye 4 months back. B-scan performed prior to the surgery documented the posterior chamber as anechoic. On examination, the best-corrected visual acuity was no perception of light (NPL) in the left and 20/20 in the right eye. The intra-ocular pressure (IOP) of both eyes was within the normal range. The examination of the right eye was unremarkable. On slit-lamp examination of the left eye, corneal sutures were present, along with the presence of diffuse golden-brown pigments giving the cornea rust-colored hue [Figure 1]. Anterior chamber details could not be visualized. Existing literature describes corneal blood staining as impregnation of hemoglobin particles, intra- and extra-cellularly around the endothelium, and stromal lamellae and involving the corneal epithelium. An AS-OCT was performed, which showed hyper-reflective deposits in the corneal stroma with a greater density in the anterior stroma and sparing of the corneal epithelium, posterior stroma, and endothelium, thus raising the suspicion of ocular siderosis [Figure 2]. An orbital NCCT (non-contrast computed tomography) was ordered, which to our reckoning, confirmed the presence of a missed IOFB (intra-ocular foreign body) in the vitreous cavity [Figure 3].
|Figure 1: Slit lamp photographs showing the repaired corneal perforation with extensive rust-colored deposits in the cornea giving it a golden-brown hue|
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|Figure 2: Anterior segment optical coherence tomography showing hyper-reflective deposits in the anterior corneal stroma|
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|Figure 3: Orbital computed tomography showing the hyper-intense IOFB (arrow)|
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| Discussion|| |
Both siderosis and ocular blood staining have a similar rust-colored clinical appearance. Ocular blood staining is generally an outcome of hyphema along with endothelial dysfunction with or without a raised IOP. Described histopathology and microscopy features, of a blood-stained cornea suggest diffusion of hemoglobin and its breakdown products from an intact Descement's membrane into the entire cornea.
In this case, NPL in the left eye in the absence of a high IOP was unlikely to be linked to corneal blood staining alone.
However, contrary to blood staining, ocular siderosis is characterized by degenerative changes secondary to the retained, iron-containing, intra-ocular foreign body (IOFB).
Clinical findings in siderosis are multiple, extending from the cornea anteriorly to the retinal pigment epithelium and optic nerve posteriorly. Iron has a predilection for the epithelium, particularly that of the iris, lens, and retinal pigment; other sites of affinity include the corneal stroma. Ferritin deposits in the siderosomes within the cytoplasm of affected cells. Histopathological studies observed the presence of siderosomes within keratocytes, with relative sparing of the corneal epithelium until late in the disease process. The Descemet membrane and the endothelium usually remain free of the pigments. On confocal microscopy of a siderotic cornea, the density of the reflective particles was the highest in the anterior stroma, which has the highest keratocyte density.
Because of the lack of access to confocal microscopy and inability to perform histopathology, a large number of clinicians rely on AS-OCT for corneal imaging. As observed in our case, the high density of keratocytes with siderosomes in the anterior corneal stroma explains the hyper-reflectivity obtained on the AS-OCT. This AS-OCT feature correlates well with the histopathology and confocal findings of previously documented ocular siderosis cases.
| Conclusion|| |
Our case highlights the AS-OCT features of ocular siderosis and emphasizes the thorough evaluation of patients with open globe injury in order to avoid such disastrous outcomes.
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
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]