Eye metallosis is a pathology that develops due to the ingress of a metal fragment into the eye. The clinical picture is represented by a decrease in visual acuity, the appearance of “floating opacities”, “fog” in front of the eyes, pronounced discomfort, increased tearfulness, photophobia. Diagnostics includes visometry, biomicroscopy, perimetry, gonioscopy, ultrasound, non-contact tonometry, orbit radiography. Treatment tactics are reduced to the removal of a foreign body. Additionally, the appointment of unithiol, anti-inflammatory antibacterial agents is shown.
Eye metallosis is a disease that is often considered in the context of occupational pathologies. The disease is most common among metallurgists, turners, welders. According to the statistics collected in ophthalmology, about 78% of cases are caused by non-compliance with safety regulations at work. The ratio of the occurrence of siderosis to chalcosis is 2:1. The development of the classical clinical picture of chalcosis is observed only if the alloy of the fragment consists of at least 85% copper. Metallosis is more often diagnosed in men of working age, which is associated with working conditions. There is a widespread prevalence.
The occurrence of the disease is caused by the ingress of a metal fragment into the eyeball. The main risk factors are represented by non-compliance with personal safety rules when working with metal in domestic or industrial conditions. In rare cases, siderosis develops with the deposition of endogenous iron formed from blood elements in massive intraorbital hemorrhages. The introduction of copper-containing foreign bodies into the eye socket is more often provoked by traumatic injuries due to the explosion of cartridges, mines, grenades. Clinical symptoms of chalcosis progress when not only copper, but also copper alloys get into the eye.
Metallosis occurs if the metallic foreign body of the eye has not been removed in a timely manner. Oxidation of the fragment leads to toxic-dystrophic changes in intraocular structures. The development of siderosis provokes the toxic effects of iron oxidation products. This leads to the staining of nearby structures in a rusty shade, clouding of the lens and neuroretinopathy. In the pathogenesis of chalcosis, the leading role is given to oxidative processes caused by copper. Pigment deposits acquire a yellow-green or blue hue. First of all, the lens, the cornea and the retina are affected.
Eye metallosis is an acquired pathology. Depending on the type of metal that the foreign body consists of, the disease is classified into siderosis and chalcosis. In accordance with the clinical classification , the following stages are distinguished:
- I – latent. It is characterized by the development of typical signs of traumatic injury: the formation of a perforation, secondary changes in intraocular structures, the presence of foreign metal particles.
- II – initial manifestations. The appearance of symptoms is caused by oxidative processes that are provoked by a pathological agent in the orbital cavity. The posterior surface of the cornea is pigmented. Pulverized pigment deposits are visualized on the membranes of the anterior segment of the eyeball and in the vitreous body.
- III – advanced metallosis. Pigment deposits penetrate into the thickness of the cornea and iris, lens, vitreous. Retinal lesion has the form of retinitis pigmentosa.
- IV – total. Massive deposition of pigmentocytes leads to clouding of the lens, destructive changes in the membranes.
Symptoms of eye metallosis
At the initial stage of the disease, patients complain about the injury of the eyeball with a metal fragment. There is a pronounced pain in the eye socket, a subconjunctival hemorrhage is formed. Pain radiates to the area of the brow arches, frontal and temporal lobes. Even with a small size of foreign particles, patients note pronounced discomfort, which is accompanied by burning, pain in the eyes, increased lacrimation. Further symptoms are caused by toxic-dystrophic changes in the structures of the eye. A specific symptom of chronic chalcosis is heterochromia of the iris, in which a greenish color is determined on the side of the lesion. Less often it is possible to visualize the Kaiser-Fleischer ring appearing on the border of the cornea and sclera.
A characteristic manifestation of siderosis is hemeralopia, in which dark adaptation is sharply disrupted. In the direct form of the disease, a hyperpigmentation zone is detected around the fragment. The indirect variant of pathology has no specific symptoms for a long time. Usually a metal fragment becomes an accidental diagnostic find. When the macular zone is affected, visual acuity sharply decreases, a “veil” or “fog” appears in front of the eyes. The progression of pathology leads to blindness. The consequence of damage to the paramacular sections is the formation of cattle, peripheral vision impairment, photophobia.
With small fragments, pathology has an asymptomatic course for a long time, but pigment dispersion leads to the progression of secondary complications. The defeat of the retina is manifested by the appearance of “flies” in the field of vision, which indicates the detachment of the shell. With dystrophic changes in the vitreous body, patients find “floating opacities” in front of their eyes. Visual dysfunction is manifested by photopsias, metamorphopsias. A typical clinical picture of metallosis develops several months or even years after a penetrating wound.
In most cases, this pathology is complicated by cataract, which is caused by the accumulation of pigment particles in the thickness of the lens. When the process spreads to the inner shell, its detachment occurs. Violation of intraocular hydrodynamics leads to secondary glaucoma. In most patients, it is possible to diagnose signs of ophthalmohypertension. The opacity of the vitreous body can turn into its complete destruction. The most severe complication of metallosis is complete blindness. Mechanical damage to the uveal tract provokes hemorrhages in the vitreous or anterior chamber.
The diagnosis is based on anamnestic data, physical examination of the patient by an ophthalmologist and the results of instrumental diagnostics. Traumatic damage to the eyeball is visually determined, less often – scarring of the membranes. From the anamnesis, it is possible to establish a connection between the development of the disease and trauma, surgical intervention. The complex of ophthalmological examination includes:
- Visometry. At stage 1-2, visual acuity decreases slightly. The increase in secondary changes at stages 3-4 leads to severe visual dysfunction up to blindness.
- Perimetry. The visual field narrows in a concentric type.
- Gonioscopy. Makes it possible to identify pigment deposits in the corner of the anterior chamber. By the color of pathological inclusions, one can judge the type of metal. Blue or greenish color indicates copper, brown – an iron foreign body.
- Ultrasound of the eyes. It allows you to visualize a foreign body in the cavity of the eye socket, as well as changes in the posterior pole of the eyeball with clouding of the lens. The inhomogeneous echogenic structure of optical media is determined.
- Non-contact tonometry. When pigmentocytes block the drainage system, intraocular pressure increases.
- Biomicroscopy of the eye. At stage 1, minor changes in optical media, scars on the cornea, signs of traumatic cataract are visualized. At stage 2, surface pigment deposits are observed on the iris, the anterior capsule of the lens. The nature of destructive changes is granular, less often filamentous. At stage 3, deep penetration of sediments causes the development of cataracts, the formation of “cotton-like” opacities.
- Ophthalmoscopy. Upon examination of the fundus, signs of retinitis pigmentosa are determined. Due to pathological inclusions of the retina, cases of its peripheral detachment are common.
- Radiography of the orbit. Allows to identify radiopaque foreign particles, to establish their localization and the nature of damage to the bone walls.
Treatment of eye metallosis
Treatment of patients with eye metallosis is carried out in two stages. First, surgical removal of a foreign body from the orbital cavity is shown. In the presence of an inflammatory reaction from the ocular membranes, a short course of antibiotics and glucocorticosteroids is required. The duration of conservative therapy is 5-7 days. With a high risk of narrowing of the pupillary opening, instillations of mydriatics are prescribed. Additionally, intravenous administration of proteolysis inhibitors, vitamin therapy can be used. The use of unithiol ensures the binding of toxic metal products with their subsequent conversion into inactive compounds. The effectiveness of potassium iodide has been proven only at stage 1, to a lesser extent – stage 2 of the disease.
The tactics of managing patients at the next stage is determined by the nature of secondary changes on the part of the eye. The development of cataracts requires phacoemulsification followed by implantation of an intraocular lens (IOL). If symptoms of ophthalmohypertension occur, hypotensive therapy is prescribed. In the case of secondary glaucoma, conservative treatment is ineffective, therefore, surgical restoration of the outflow routes of intraocular fluid is indicated. At the first signs of retinal detachment, laser coagulation is performed. With pronounced destruction of the vitreous body, vitreolysis is performed. Total lesion requires vitrectomy.
Prognosis and prevention
The outcome of the disease is determined by many factors (localization, the size of foreign particles, the course of the wound canal, the stage of the disease). Timely treatment for 1-3 art. often helps to stabilize the process and preserve vision. At stage 4, a total lesion leads to irreversible loss of vision, however, with a paramacular arrangement of a metal fragment, minor visual dysfunction is possible. Specific methods of prevention have not been developed. Non-specific preventive measures are reduced to the use of protective glasses when working with alloys and metal by persons from the risk group (welders, metallurgists, turners).