Siderosis Bulbi Research Articles

Siderosis bulbi: A rare case report and review of the literature

Bunge first reported siderosis, an eye condition brought on by a ferrous intraocular foreign substance, in 1890. A pigmentary and degenerative eye condition known as siderosis bulbi results from the retention of an intraocular foreign material that contains iron. Siderosis bulbi is produced as a result of the ferrous ions dispersing the vitreous humor, aqueous humor, and surrounding tissue in that order. Patients often arrive at the emergency room with an anterior chamber intraocular foreign body.

Management of intraorbital metallic foreign body with lateral orbitotomy and c-arm guiding surgery: a challenging case

Introduction: Orbital trauma is an emergency condition that often occurs with increasing mobility and industry. An intraorbital foreign body is one of the traumas that occur in the orbit. An intraorbital foreign body is an entrapment of corpus alienum in the orbital cavity, either accompanied by orbital fracture or not accompanied by fracture. Case Report: We report a 31-year-old man who suffered ocular trauma and had a rusty hammer splinter foreign body stuck in the orbital cavity of the right intraconal region. The patient was found with an initial suspicion of IOFB, but investigations with a head CT scan could not detect the presence of IOFB. The treatment of choice for this patient is a lateral orbitotomy with C-arm fluoroscopy guiding. Panuveitis occurred in the patient's eye after the extraction of the corpus alienum was performed. Suspicion of inflammation caused by siderosis bulbi cannot been ruled out. Discussion: Suspicion of the presence of an intraorbital foreign body can be based on several clinical symptoms and patient complaints and the presence of port d' entry through the cornea, sclera, or eye adnexa. Management of intraorbital foreign body depends on the type of foreign body, its location in the orbit and the presence or absence of accompanying complications. Lateral orbitotomy with c-arm guiding in this patient successfully extracted an intraconal foreign body using the S-Stallar Wright incision technique. Avoid ocular complications due to intraorbital foreign body retention include orbital cellulitis, chronic cutaneous fistula, optic neuropathy, extraocular muscle rupture, bulbar perforation, intracranial penetration, intraorbital arteriovenous fistula, and chorioretinal atrophy. Conclusion: The management of intraorbital foreign bodies depends on the type of retained foreign body, whether inert or non-inert/toxic. So that it can prevent patients from threatening intraorbital and intraocular complications.

Multimodal Imaging of Corneal Manifestation of Siderosis Bulbi

Multimodal Imaging of Corneal Manifestation of Siderosis Bulbi

Intralenticular metallic foreign body – A case report

A case of penetrating intraocular foreign body presented with a mild blurring of vision, without any ocular reaction. Intralenticular foreign bodies are sometimes missed and present with complications in the later stage including uveitis, traumatic cataract, endophthalmitis, and siderosis bulbi. We encountered a young male with an intralenticular metallic foreign body measuring 1 mm with a sealed corneal wound of entry measuring 1mm, confirmed with anterior segment optical coherence tomography (OCT). Metallic foreign body was visible within the lens matter after dilated anterior and posterior segment examination. Intralenticular foreign body was removed, and lens extraction was done with intraocular lens (IOL) implantation to prevent any ocular complications. Postoperatively, the vision improved to 6/6 with glasses.

Clinical Characteristics and Visual Outcomes in Patients with Intralenticular Foreign Bodies with Self-Sealing Corneal Penetrating Wounds

Purpose Siderosis bulbi may occur as a result of retained intralenticular foreign bodies (ILFBs) that were missed during examination in patients with self-sealing wounds and without a significant decrease in visual acuity. This study aimed to explore the clinical characteristics and visual outcomes of ILFBs with self-sealing corneal penetrating wounds. Methods Fifteen eyes of 15 patients with ILFBs and self-sealing corneal penetrating wounds, seen between October 2014 and September 2019, were retrospectively analyzed. Data regarding the patient demographics, clinical features, surgical procedure, and initial and final best-corrected visual acuity (BCVA) were analyzed. Results All patients were male with a mean age of 41 years. The foreign bodies passed through the cornea, sometimes through the iris, through the anterior capsule, and finally localized in the lens. All ILFBs were pointed and metallic objects and were successfully removed with phacoemulsification and posterior chamber intraocular lens (IOL) implantation. Anterior capsule violation was found in three eyes, but no posterior capsule rupture was found. The IOL was placed in a capsule bag in all the cases. The BCVA ranged from 20/200 to 20/25 preoperatively and improved to between 20/32 and 20/20 at the last follow-up visit. The IOLs were well-centered. Apart from posterior capsule opacity in four eyes, no other postoperative complications were found. Conclusions In patients with a pointed metallic ILFB and self-sealing corneal penetrating wounds (with or without cataracts), early diagnosis and removal of the metallic ILFB combined with lens removal and IOL implantation may avoid late complications and achieve good visual outcomes.

Pigmentation of optic discs.

A 41-year-old female presented with perception of light in right eye and counting fingers vision in left eye since 6 months. She was a known case of autoimmune hepatitis and bilateral optic neuritis. Fundus examination revealed bilateral disc pallor with peripheral pigmentation of optic discs [Fig. 1a and b]. Optic disc pigmentation can occur in ocular abnormalities like optic disc hypoplasia, distended retinal vessels, iris transillumination defects, ptosis, nystagmus, and siderosis bulbi.[1234] Optic disc pigmentation after an episode of optic neuritis is rare. Optic disc pigmentation is a rare entity and ophthalmologists should rule out ocular and systemic associations.Figure 1: Fundus Photographs of right eye (a) and left eye (b) showing optic disc pigmentationDeclaration 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.

Visual loss resulting from siderosis bulbi caused by a missed intraocular foreign body

Introduction: Intraocular foreign bodies (IOFB) represent an important cause of visual impairment, especially within the group of working age population. Case report: A 38-year-old male presented with severe left eye pain, accompanied by left headache, visual loss, redness, photophobia, tearing and nausea, 30 months following a minor left eye trauma when hammering metal on metal. Eye ultrasound identified a small intraocular foreign body as well as the crystalline lens luxated into the vitreous cavity. Pars plana vitrectomy was carried out with the extraction of the foreign body and of the lens. Pain was relieved, but vision was not regained. Conclusion: The poor outcome of this case follows from a combination of unusual factors: ophthalmologists’ failure to identify an occult IOFB and the lack of patient’s concern about his eye condition, until the moment when he experienced excessive pain and vision was already lost.

Pseudo retinitis pigmentosa in a case of missed intraocular foreign body

A 35-year-old man presented with history of painless, progressive loss of vision in the left eye for the past 7 years. There was history of trauma to the same eye...

Siderosis bulbi resulting from an intraocular metalic foreign body: case report

Siderosis bulbi is a sight-threatening condition characterized by a pigmentary and degenerative change in the eye that follows the intra-ocular retention of a foreign body containing iron. The main cause of ocular siderosis is penetrating trauma mostly by hammering a steel object without or with poor eye protection. Herein, we report a case of siderosis bulbi after penetrating trauma that was lately treated with vitrectomy to remove the foreign body, and despite treatment resulted in ocular globe atrophy.

English

Atypical case of retained intraocular foreign body presenting as secondary glaucoma after 12 years. To report a case of retained intraocular foreign body presenting as glaucoma after 12 yrs. A 24 yrs old male patient came to OPD, with pain & redness in right eye since 2 days. He was operated for cataract 12 years back. On examination, OD VA- hand movements. Slit lamp examination revealed corneal edema and deep anterior chamber. Rest of the details was not clear. OS Findings were normal. IOP: OD- 50 mmHg, OS-16 mmHg. After control of IOP with medications, following findings were noted: Corneal scar in paracentral zone. RAPD present in right eye. Iris hole present at 3'0 clock position. FUNDUS: Vitreous is clear. Intraocular foreign body of size half disc diameter present over the optic disc. Disc is pale, with attenuated vessels & peripapillary pigmentary changes. Yellowish speckled lesions present surrounding the vessels and dull foveal reflex. Gonioscopy revealed open angles with increased pigmentation. Visual fields showing advanced field defects. CT & B scan showing radio opaque foreign body over disc. Electro retinogram of right eye showing reduced response to all stimuli. Removal of foreign body not done because of poor visual prognosis & risk of symphathetic ophthalmitis. CONCLUSION: Retained metallic Intraocular foreign body can manifest after many years with varied presentation like secondary glaucoma without classical features of siderosis bulbi.

Siderosis bulbi. Clinical presentation of a case of three years from onset

Case reportThe clinical and functional characteristics of a 30 years-old patient with three years-evolution siderosis bulbi are described in this paper, as well as the treatment using phacoemulsification and vitrectomy for the elimination of the metallic remains. DiscussionIn spite of the fact that the majority of the intraocular foreign bodies (IOFB) have a dangerous immediate effect, in cases of small, local bodies and with little visual deterioration, observation is possible. Nevertheless, with time, the iron settles on the pig-mented epithelium of the retina, producing changes at macula and peripheral level, which are responsible for the gradual loss of vision. The surgical removal of the IOFB can stop the progression of this pathology.

Siderosis bulbi. Presentación clínica de un caso de tres años de evolución

Case reportThe clinical and functional characteristics of a 30 years-old patient with three years-evolution siderosis bulbi are described in this paper, as well as the treatment using phacoemulsification and vitrectomy for the elimination of the metallic remains. DiscussionIn spite of the fact that the majority of the intraocular foreign bodies (IOFB) have a dangerous immediate effect, in cases of small, local bodies and with little visual deterioration, observation is possible. Nevertheless, with time, the iron settles on the pigmented epithelium of the retina, producing changes at macula and peripheral level, which are responsible for the gradual loss of vision. The surgical removal of the IOFB can stop the progression of this pathology.

Influence of posterior intrascleral iron foreign body on rabbit retina and opticus

Background Iron-containing foreign body trapped in the eyeball wall without affecting the opticus occurs occasionally in clinic. Operation always is performed in an attempt to avoid the deposition of rust in different tissues of the eye-balls. However,a few animal experimental studies showed that a small foreign body does not affect the retina and opticus in the period of three months. The question of whether surgery needs to be carried out is worth discussion. Objective The aim of this study was to evaluate the influence of posterior intrascleral iron foreign body on the rabbit retina and opticus. Methods Twelve healthy adult Japan flap-eared white rabbits were randomly divided into two groups. Medium carbon iron with rust or without rust( size of 2. 0 mm × 1. 0 mm×0. 2 mm) were implanted into the posterior sclera of the left eye to create the animal model with iron foreign body in the eyeball wall. The cornea, anterior chamber, crystalline lens, vitreous and fundus of the rabbits were observed under a slit lamp microscope 1 week before operation and 1 week, 2 weeks, 1 month and 3 months after operation. Flash electroretinogram(F-ERG) and flash visual evoked potential (F-VEP) were recorded at the time points mentioned above. All the rabbits were sacrificed and the eye balls were extracted at the end of the experiment, and the position of the iron foreign body was determined. The histopathological examinations of the retina and opticus were performed under the light microscope. This experiment complied with the Regulations for the Administration of Affair Concerning Experimental Animals by State Science and Technology Commission. Results There were no statistical differences for the a-wave amplitude of F-ERG among different time points( F =1. 885,P =0. 129 ) and different treatment groups ( F =1. 188, P =0. 340 ), as with the ERG b-wave amplitude ( time: F =2. 73, P =0. 064 ; group : F =1. 114, P =0. 367). The differences in the latencies of F-VEP N1-wave were insignificant among the different time points( F =1. 605, P =0. 263 ) as well as various groups ( F=1. 556, P =0.314 ), and those of F-VEP P1 -wave were not evidently changed ( time: F =2. 329, P =0. 092 ; group : F =2. 186, P =0. 103 ). No correlations were seen between the time factor and grouping factor ( P ＞ 0. 05 ). There was no apparent siderosis bulbi change during the follow-up duration. No morphological abnormality in the retina and optical nerve was found under the light microscope. At the end of the experiment,intrascleral iron foreign body was wrapped by surrounding tissue in a stable condition. Conclusions The small posterior intrascleral iron foreign body, whether it is oxidized or not, does not produce distinctive functional or pathological damage on retina and opticus in the short term. Key words: Eye injury ; Scleral/foreign body; Visual electrophysiology ; Visual function ; Pathology

Siderosis bulbi nach intraokularem Metallfremdkörper

We report the case of a 42-year-old patient who presented with unilateral loss of vision in the left eye. The clinical examination revealed retinal detachment and a low intraocular pressure was found in the left eye. Except for an extinct electroretinogram (ERG) and a siderosis bulbi in the left eye no signs of an intraocular body were detectable, either in the ultrasound B-scan or in the clinical examination. Pars plana vitrectomy with silicon oil tamponade was performed and revealed an iron-containing body next to the fovea which was removed without any complications. Despite an initially easily visible retinal detachment, a newly acquired siderosis bulbi in combination with ocular trauma in the clinical history should raise the suspicion of a residual intraocular iron foreign body, until this can be disproven.

Visual Outcome following Intraocular Foreign Bodies: A Retrospective Review of 5-Year Clinical Experience

To determine the main prognostic factors related to final visual acuity (VA) after intraocular ocular foreign body (IOFB) extraction. We performed a retrospective chart review of 80 patients (84 eyes) who underwent surgical removal of IOFBs and repair of associated ocular trauma. Data on age, gender, presenting clinical features, characteristics of IOFB, complications, interval between time of injury and IOFB removal, and final VA were recorded and analyzed. Male adults were the major population affected by IOFBs. Improved vision outcome was obtained after the removal of IOFBs and surgical repair of the eyes (p=0.011). Factors showing statistical association with final VA included initial VA (p=0.000), size of IOFB (p=0.010), IOFB location inside the eye (p=0.000), and preoperative retinal detachment (p=0.011). Factors showing no statistical association with final VA included nature of IOFB (p=0.445), entrance wound location, other IOFB-related complications (such as cataract, vitreous hemorrhage, secondary glaucoma, hyphema, endophthalmitis, siderosis, and atrophia bulbi), and interval between injury and IOFB removal. Prognostic factors for poor final VA related to IOFBs included poor initial VA, large IOFB size, posterior segment location, and preoperative retinal detachment.

Lens Siderosis Resulting from a Tiny Missed Intralenticular Foreign Body

We report a patient with clinical ocular siderosis at the time of presentation but undetectable intraocular foreign body on computed tomography (CT) and ultrasonography. A 24-year-old man suffered from right ocular injury when hammering metal on metal. Slit-lamp examination revealed a small corneal perforating wound and an iris hole, but no intraocular foreign body was found under fundus examination. There was also no evidence of intraocular foreign body on ultrasonography and orbital CT scan. About 1 month later, lens siderosis with cataract formation developed, and the patient received lens extraction with intraocular lens implantation. During the operation, a small (< 1 x 1 x 1 mm in size) intralenticular foreign body of metal material was found and removed. The patient's visual acuity improved from 6/20 to 6/6 on the next day. A patient suspected to have intraocular foreign body should be followed-up closely; it is better to remove the foreign body before siderosis bulbi occurs.

Iron-generated hydroxyl radicals kill retinal cells in vivo: effect of ferulic acid

Siderosis bulbi is vision threatening. An investigation into its mechanisms and management is crucial. Experimental siderosis was established by intravitreous administration of an iron particle (chronic) or FeSO(4) (acute). After siderosis, there was a significant dose-responsive reduction in eletroretinogram (a/b-wave) amplitude, and an increase in OH level, greater when caused by 24 mM FeSO(4) than that by 8 mM FeSO(4). Furthermore, the FeSO(4)-induced oxidative stress was significantly blunted by 100 microM ferulic acid (FA). Siderosis also resulted in an excessive glutamate release, increased [Ca(++)](i), and enhanced superoxide dismutase immunoreactivity. The latter finding was consistent with the Western blot result. Obvious disorganization including loss of photoreceptor outer segments and cholinergic amacrines together with a wide-spreading ferric distribution across the retina was present, which were related to the eletro-retinographic and pathologic dysfunctions. Furthermore, b-wave reduction and amacrine damage were respectively, significantly, dose-dependently, and clearly ameliorated by FA. Thus, siderosis stimulates oxidative stress, and possibly, subsequent excitotoxicity, and calcium influx, which explains why the retina is impaired electro-physiologically and pathologically. Importantly, FA protects iron toxicity perhaps by acting as a free radical scavenger. This provides an approach to the study and treatment of the iron-related disorders such as retained intraocular iron and Alzheimer disease.

Delayed Intraocular Foreign Body Removal without Endophthalmitis during Operations Iraqi Freedom and Enduring Freedom

To report the long-term follow-up results of intraocular foreign body (IOFB) removal at Walter Reed Army Medical Center during Operation Iraqi Freedom and Operation Enduring Freedom from February 2003 through November 2005 and to determine the prognostic factors for visual outcome in this patient population. Retrospective, noncomparative, interventional case series. Seventy-nine eyes of 70 United States military soldiers deployed in support of operations Iraqi Freedom and Enduring Freedom sustained IOFB injuries and subsequently were treated at the Walter Reed Army Medical Center with a minimum of 6 months of follow-up. The principal procedure performed was 20-gauge 3-port vitrectomy with IOFB removal through limbal or pars plana incision. Final visual acuity, rate of proliferative vitreoretinopathy, rate of endophthalmitis. Average patient age was 27 years, with an average of 331 days of postoperative follow-up. Average IOFB size was 3.7 mm (range, 0.1-20 mm). Median time to IOFB removal was 21 days (mean, 38 days; range, 2-661 days). Mean preoperative visual acuity was 20/400 (1.36 logarithm of mean angle of resolution [logMAR] units) and mean final visual acuity was 20/120 (0.75 logMAR). Of the patients, 53.4% achieved visual acuity of 20/40 or better, whereas 77.5% achieved visual acuity of better than 20/200. There were no cases of endophthalmitis (0/79 eyes; 95% confidence interval, 0%-3.1%), siderosis bulbi, or sympathetic ophthalmia. Among the eyes, 10.3% evolved to no light perception or had been enucleated by the 6-month follow-up visit. Poor visual outcome correlated with extensive intraocular injury (P<0.032). Seventeen of 79 eyes (21%) experienced proliferative vitreoretinopathy. Proliferative vitreoretinopathy correlated with poor initial vision (hand movements or worse; P = 0.035) and extensive intraocular injury (P<0.001). Timing of vitrectomy did not correlate with visual outcome. The most common systemic antibiotic administered was levofloxacin, whereas the most common topical antibiotic administered was moxifloxacin. Poor visual outcome and postoperative complication rates are related to extensive intraocular injury. Delayed IOFB removal with a combination of systemic and topical antibiotic coverage can result in good visual outcome without an apparent increased risk of endophthalmitis or other deleterious side effects.

Siderosis bulbi resulting from an intralenticular foreign body

PURPOSE: To report a case of siderosis bulbi that resulted from a small intralenticular foreign body.METHOD: Case report.RESULTS: A 36-year-old man with normal visual acuity and a peripheral intralenticular iron foreign body in the left eye was treated conservatively. Nine weeks after the injury, he had ocular signs of siderosis bulbi, with changes in the electroretinogram. A clear lens aspiration with removal of the foreign body was performed. After removal of the iron foreign body, no progression or regression of the ocular signs of siderosis bulbi has occurred, and the electroretinogram has not changed over a 2-year period.CONCLUSIONS: Even in the presence of good vision, a patient with an intralenticular ferrous foreign body should be followed closely, and the foreign body should be removed before irreversible siderosis bulbi occurs.

Management of Siderosis Bulbi due to a Retained Ironcontaining Intraocular Foreign Body

The authors report their experience in managing 14 cases of siderosis bulbi secondary to a retained iron-containing intraocular foreign body (IOFB). The IOFB was removed in 12 of the 14 eyes. The IOFB was removed with a sclerotomy and external magnet (5 eyes), a pars plana vitrectomy (PPV) and intraocular forceps (5 eyes), a PPV and intraocular magnet (1 eye), and a PPV with aspiration using the suction mode of the vitrectomy instrument (1 eye). A siderotic cataract developed in 11 eyes and cataract extraction resulted in postoperative visual acuity ranging from 20/15 to 20/40. The most recent siderotic cataracts have been managed with cataract extraction and posterior chamber intraocular lens (PC 10L) implantation. No patient in this series experienced visual deterioration after receiving medical attention. The current management of siderosis bulbi is discussed.