Siderosis Bulbi
Zamzam Al-baker,MD
Consultant Opthalmology
Ophthalmology depart./Hamad
Medical Corporation-Qatar
Ocular History
 10 year old boy .
 January /2005: OS: recurrent redness and photophobia for
9 months , improved after topical steroids
 gradual decreased vision since 3 months
 he remembered a trivial non-specific ocular trauma 12
months back.
Ocular History
 Systemic
review and medical check up:
unremarkable
 Laboratory blood investigations and
systemic uveitis work-up : normal
December 2005 - First Presentation
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VA: OD 20/20, OS 20/400 .
IOP:OD 14 mmHg, OS 6 mmHg.
OD: anterior and posterior segment no cells
OS:
 Conjunctiva: mild cilary injection .
 Cornea : diffuse stromal haze and brown
discoloration with white large keratic precipitates
inferior
First Presentation
 A/C: deep, 3 + cells.
 Pupil: 6mm, round with multiple areas of
posterior synechia, on dilatation with multiple
brown-rusty deposits on anterior lens capsule.
 Lens: 3+ nuclear & PSCC cataract
 Vitreous: 2+ Vitreous haze
 Fundus: hazy view, scattered RPE clumping,
pigmented shadow at inferior temporal quadrant
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Rusty brown deposits on anterior lens capsule
First Presentation - Ultrasound
Vitreous opacities with small foreign body on the retina with posterior shadow effect
Further Investigations
 ERG: patient was not cooperative
 CT scan orbit: no foreign body seen
Diagnosis
Siderosis Bulbi
Masquerading as Panuveitis
Treatment – Follow up
 December- 2006
 anterior granulomatous reaction was
controlled with topical steroids drops
 January-2006
 OD phacoemulsification + parsplana
vitrectomy + removal of intraocular
foreign body +intraocular lens implant +
silicon oil tamponade
Follow-up – June 2006
 VA: 20/400
 cornea: stromal haze and brown deposits
 A/C: clear
 pale optic disc
 generalized RPE clumbing, flat retina centrally
under silicone oil
 inferior tractional detachment with subretinal
fibrosis
 Patient did not attend for further follow up
Conclusion
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Metallic FB are electrolytically dissociated or react
with the tissue-fluid to form decomposition product,
usually by oxidation and cause specific toxic
reaction such as siderosis or chalosis.
The clinical manifestations of ocular siderosis result
from a chronic degenerative process presumably
induced by the oxidation of reduced forms of
elemental iron that result in the libration of toxic
oxidants can mimic multiple other uveitis disorders
Clinical Manifestations of ocular Siderosis
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Rust-colored corneal stroma
Iris heterochromia (affected side is darker)
Pupillary mydriasis
Chronic uveitis
rust-colored anterior subcapsular deposits
Cataract
Lens sub-luxation
Secondary glaucoma
Retinal pigmentary changes.
Diagnosis of Ocular Siderosis
 suspicion
 detailed history
 complete ocular examination
 gonioscopy
 X-ray , CT scan
 US, ERG, EOG
Comments
 In this case the presence of unilateral
granulomatous panuveitis in such age alerted us to
the possibility of masquerade.
 There were other anterior segment signs typical for
ocular siderosis, like the rusty corneal stromal
haze, and the brown rustic anterior subcapsular
deposits .
Conclusion
 Siderosis seems to be more advanced
when the foreign body is located in the
posterior segment.
 Foreign bodies tend to be better
tolerated when located in the anterior
chamber or imbedded in the lens.
Conclusion
 The natural course of a retained IOFB varies
 small IOFBs may be completely resorbed, the
FB may become encapsulated
 the siderotic changes may stabilize or regress
 the FB may lose its magnetic properties or
become radiolucent to X-rays
 or progressive siderotic changes may occur.
Conclusion
 Siderotic changes have been reported to occur
from 18 days to 8 years after the injury
 The VA at presentation is an indicator for the
final VA in severe forms of siderosis
 Hypotony and retinal pigment changes are
signs of advanced severe cases of ocular
siderosis