Corneal Copper Deposition Secondary to Oral Contraceptives

Abstract

To document two cases of corneal pigmented rings and hypercupremia associated with estrogen-based oral contraceptive use. Other causes of corneal pigment rings including Kayser-Fleischer rings and the previously documented association of estrogens and hypercupremia are discussed. Two healthy female patients presenting to a general optometric practice for routine examinations were found to have bilateral bluish-green corneal deposits at the level of endothelium/Descemet's membrane. The deposits were predominately in the inferior midperiphery in both patients, but formed a complete ring 3 years after initial presentation in one. Both patients were found to have abnormally elevated serum copper and elevated ceruloplasmin levels, and both were taking estrogen-based oral contraceptives. Serum copper levels returned to normal levels soon after cessation of the oral contraceptives, and subsequently re-elevated when a different oral contraceptive agent was tried. Although the pigment rings appeared different from typical Kayser-Fleischer rings, both patients were referred to gastroenterologists to rule out Wilson's disease. This is believed to be the first report of corneal pigment deposition and hypercupremia associated with oral contraceptive use. Recognition of these potential side effects by eye care practitioners and prescribing physicians may spare patients the expense and morbidity risk of unnecessary medical testing. Further research is needed to determine the exact nature of the deposits (presumed to be a copper compound), and whether it may be accumulating to dangerous levels in other body tissues as in Wilson's disease.