Delayed Diagnosis in a Case of Siderosis Bulbi
Domke N., Pittasch K., Meier P.
Department of Ophthalmology, University of Leipzig
Purpose: After penetration or perforation by a metallic object searching for an foreign body is absolutely necessary. The appearance of iris heterochromia is typical for siderosis bulbi. Removal of the foreign body is necessary as soon as possible to prevent further damages.
Method: In 2002 a clearly visible heterochromia could be seen in two patients. Patient no.1 has been presented with a persisting ceratitis after extraction of a cataracta traumatica. Patient no.2 has already been treated because of foreign body sensation and loss of visual acuity after an accident 18 month ago. He was suffered from iritis and glaucoma secundaria. History of patient no.1 showed a contusio bulbi, in history of patient no.2 a penetrating injury occurred.
Results: In both cases an acquired heterochromia - brownish change of the iris colour - and affection of the cornea has been diagnosed. Concerning patient no. 2, a corneal scar and an iris foramen gave indication to an occurred penetration. The ultrasound/ultrasound-biomicroscopy confirmed the suspicion of an exisisting intraocular foreign body. The ERG of the affected eye showed an "amplitude-suppression", which indicates an advanced damage of the retina. The computer tomography showed the foreign body which was removed by operation immediately.
Conclusions: Acquired heterochromia is suspicious of an intraocular metallic foreign body. Further diagnostic procedures are conventional x-ra
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