Description

A 34-year-old man, an electrician by occupation, presented with blurring of vision and pain in his right eye for the past 5 days. He had consulted elsewhere and was diagnosed with an intra-lenticular foreign body and was prescribed topical antibiotics, anti-inflammatory and antiglaucoma drops. The patient was not aware of any recent trauma; on examination, the patient had a best-corrected distance visual acuity (BDVA) of 20/20 in the right eye and 20/20 in the left eye. On slit-lamp biomicroscopy, the right eye had mild conjunctival congestion and a nebular grade corneal scar located in the paracentral cornea at about 6 o’ clock, with a small fragment of copper wire embedded in the lens matter from 6o c to 9o c lock, and an intact posterior capsule. The anterior chamber showed 1+cells and intraocular pressure was 18 mm Hg (figure 1). Posterior segment examination was unremarkable without any evidence of a foreign body. The computed tomography scanconfirmed the location of the isolated intralenticular foreign body. The anterior and posterior segment examination of the left eye was unremarkable. The patient underwent foreign body removal with lens aspiration and intraocular lens implantation in the right eye, given the risk of anterior uveitis with raised intraocular pressures. At the 1-month postoperative visit, his BDVA was 20/20, with no conjunctival congestion and a quite anterior chamber without any cellular reaction.

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Figure 1

(A) Diffuse slit lamp image showing nebular grade corneal scar at 6 o’ clock (blue arrow), copper coloured foreign body within the lens, surrounded by a localised lenticular opacity. (B,C) The intralenticular foreign body identified via optical section and retro illumination techniques (blue arrow shows the corneal scarring). (D) A magnified view of the intralenticular foreign body.

Intralenticular metallic foreign bodies usually cause localised opacities or lead to the development of total cataracts depending on the size of the foreign body and its chemical contents. Ocular toxic effects are usually not encountered since the lens capsule acts as a barrier.1 In our case, the foreign body was a fragment of coated copper wire present within the substance of the crystalline lens. Additionally, copper foreign bodies are known to induce a fibrous capsulation around them, which reduces the potential toxicity of copper to the other ocular structures as seen in our case.2 3 However, whenever encapsulation does not occur, copper can lead to devastating ocular inflammation. Indications for surgery in an encapsulated copper intralenticular foreign bodies are the formation of a cataract, anterior uveitis, glaucoma and lens subluxation. In chronic cases, chalcosis can lead to characteristic findings such as sunflower cataract, Kayser-Fleischer ring, focal pigmentary changes in the fundus, chorioretinal atrophy and endophthalmitis.4–6 Hence early surgical intervention, as in our case, provides the best opportunity to tackle the condition’s acute complications as well as preventing long-term damage while maintaining a good visual outcome.7 8