A 38-year-old male, a mechanic by occupation, presented with redness, pain, and irritation in the left eye for the past 2 weeks, with no significant systemic history. The history of ocular trauma 1 year ago was elicited. Following multiple consultations elsewhere, he used topical medications, which led to temporary resolution of symptoms, only to recur on discontinuation of the medications. On examination, the best corrected visual acuity was 6/6 in both eyes. On slit-lamp examination, circumciliary congestion was seen in the left eye, albeit without a conspicuous entry wound. Anterior chamber inflammation was observed with cells 2+ according to Standardised Uveitis Nomenclature (SUN) classification,1 with a 2 × 2 mm iron foreign body in the inferior angle Fig. 1a. Inflammatory adhesions were noted between the foreign body and the anterior surface of the iris, resulting in a corectopia toward the foreign body. Four-mirror gonioscopy revealed a rusted iron foreign body in the inferior angle of the anterior chamber, along with peripheral anterior synechiae Fig. 1b. Intraocular pressure and posterior segment examination were unremarkable. B-scan and X-ray orbit ruled out concomitant posterior segment and orbital involvement.Figure 1: (a) Slit-lamp photograph taken using oblique illumination depicts an intraocular rusted iron foreign body camouflaging with the iris at the 5 o’clock hour position with peripheral anterior synechiae and corectopia toward the IOFB. (b) Slit-lamp photograph taken through a four-mirror goniolens portraying the intraocular iron foreign body in the inferior angle of anterior chamber, along with iris adhesionsSurgical removal was performed, wherein two clear corneal incisions were made at 5 o’clock hours, and following synechiolysis, the foreign body was extracted. The postoperative period was uneventful. The patient was discharged on antibiotic and steroid eyedrops, with optimal recovery upon 2-weekly follow-up. Discussion Chronic intraocular ferrous foreign bodies result in a constellation of clinical features called siderosis, depending upon the iron concentration in the foreign body. Following dissociation, iron deposits over the cornea, lens, ciliary body, and/or sensory retina, exerting its toxic effects, causing cell death. Manifestations include corneal staining, anterior subcapsular cataract, pigmentary retinopathy, and subsequent retinal atrophy.2 Involvement of trabecular meshwork causes secondary open-angle glaucoma, called siderotic glaucoma.3 Despite such a longstanding history, none of the aforementioned features was seen, except for a protracted anterior chamber inflammatory reaction, likely due to the slow release of iron ions. Two similar cases of retained intraocular foreign bodies without associated siderosis have been reported before.4,5 Authors' Contributions Dr. Samarth Kacker- Literature search, manuscript preparation, manuscript editing. Dr. Ashwathi Deepak- Literature search, manuscript preparation, manuscript editing. Dr. Sameer Chaudhary- Design, manuscript editing, manuscript review. 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.
Kacker et al. (Thu,) studied this question.