Siderosis of the eye

Siderosis of the eye is nothing more than the deposition of iron salts in the tissues of the eye. With siderosis, all tissues of the eye are saturated with iron salts - corneal stroma, deposition of brown pigment in the form of dust on the endothelium of the cornea from the side of the anterior chamber, which creates its brown opalescence. With local siderosis, pigmentation is noted only around the fragment.

Symptoms of siderosis of the eye

The anterior chamber is of normal depth or deep (in case of damage to the ciliary ligaments (ciliary) and subluxation of the lens in advanced stages of the process). The fluid of the anterior chamber usually opalescent as a result of the presence of small particles of iron in it (yellowish-brown spots).

The iris is darker, often brown, due to the deposition of a large number of yellow-brown pigment grains. There may be free iron deposits on the surface (in the crypts) and in the stroma of the iris. In advanced stages of siderosis, the pupil reacts sluggishly to light or does not react at all.

In the iridocorneal angle, gonioscopy reveals a deposit in the form of exogenous and endogenous pigmentation of the Schlemm's canal (scleral sinus). Sometimes, complete blocking of the iridocorneal angle by pigment is observed, due to which the separation zones are not visible.

In the lens, along with the opacities caused by its injury, deposits of brown pigment grains are observed in the epithelium of the anterior capsule. In the initial stages of siderosis, deposits along the pupillary margin look like plaques, in later stages - pigment rings formed from multiple plaques. A brown ring is visible in the center of the pupil, in the cortical layers - a lighter ring, on the periphery it spreads and is noted in the form of separate dots. Sometimes there are pigment deposits along the injured canal of the lens. In advanced stages of the process, the lens can have a dark brown color.

Due to degeneration of the zonule, wrinkling of the lens and its subluxation may occur.

In the vitreous body, pronounced destruction or opacities are detected, as well as the formation of adhesions.

In the retina, clinically detectable changes are detected in the advanced stage of siderosis. They manifest themselves in the form of peripheral pigment retinitis, which is characterized by the presence of pigment foci on the fundus and in these cases resembles the picture of changes in pigment degeneration of the retina. In the late stages of the pathological process, large pigmented white atrophic foci are visible in the central areas of the fundus. In severe cases of siderosis, the optic disc is rusty in color, and in secondary glaucoma, glaucomatous excavation of the optic nerve is observed.

With a long-term presence of a fragment in the eye, developed siderosis occurs in 22% of cases, and advanced siderosis occurs in 1% of cases. Clinically expressed manifestations of siderosis are more often (in 50% of cases) encountered when a foreign body affects the eye tissue for 6-12 months. When a fragment remains in the eye for more than 3 years, changes characteristic of developed siderosis are observed, and somewhat less often, those characteristic of an advanced process.

If the fragment is located in the anterior chamber, then siderosis of the anterior part of the eye develops faster.

When a fragment is introduced into the lens, initial symptoms of siderosis are often observed, mainly in the anterior part of the eyeball.

The retina remains intact for a long time. The degree of siderosis does not depend on the size of the foreign body.

Treatment of eye siderosis

To prevent siderosis, it is recommended to use high-frequency induction currents. Since one of the first disorders in siderosis is a decrease in dark adaptation, vitamin A is used as a therapeutic effect for this disease, since it has a certain beneficial effect on the eye tissue in siderosis.

For the treatment of siderosis, Unitol (antidote for heavy metals) is recommended - in courses: the first 2 days - 3 times a day, 7.5 ml of a 5% solution of Unitol, the next 5 days - 5 ml 3 times a day intramuscularly. In outpatient settings, a Unitol solution is used 3 ml once a day. The course of treatment is 30 days. All patients are given 5% Unitol solution instillations into the conjunctival sac of the affected eye 4 to 6 times a day. In case of inflammatory phenomena caused by prolonged presence of an iron-containing foreign body in the eye, symptomatic treatment is carried out (installations of atropine, corticosteroids, disinfectants, antibiotics). Subconjunctival injections of a 5% solution of Unitol can also be used, 0.2 ml daily, the treatment course is 15 days, four courses per year.

The positive effect of Unitol on siderosis has also been noted after the fragment has been removed - in a number of patients, further development of the process is prevented, therefore Unitol is recommended for use both for the prevention and treatment of siderosis of the eye.

Prevention of siderosis of the eyes

Prevention of siderosis consists primarily in surgical intervention as early as possible, when chemically active foreign bodies enter the eye tissues. However, it is difficult to resolve the issue of preventing siderosis and chalcosis in inoperable cases or when a foreign body has been in the eye tissues for a long time, where changes have already occurred in the eye tissues under the influence of metal intoxication and after removal of the fragment, further development of the pathological process is possible.