CHALCOSIS

It is mild ocular inflammation due to an intraocular foreign body containing copper between about 70 to 85%. Chalcosis results in deposition of copper on lens capsule (sunflower cataract), Descemet’s membrane (Kayser- Fleischer ring), iris (green discolouration), sluggish pupillary response, vitreous degeneration and liquefaction, yellow retinal plaques and degeneration.

PATHOPHYSIOLOGY: -

The first is suppuration, an acute inflammatory reaction with degenerated neutrophils and few macrophages present > second pattern of histopathologic change is chronic granulomatous inflammation, consisting of plasma cells, lymphocytes and macrophages that stain positively for copper>third pattern is reactive fibrosis around the foreign body, resulting in a fibrous capsule>fourth pattern of histopathologic change is disseminated deposition of copper in various ocular structures.

SYMPTOMS: -

The features vary according to the size, location and content of copper in intraocular foreign body.

Acute Chalcosis presents rapidly with

• Inflammation
• Deteriorating vision
• Hypotony
• Retinal detachment.

Chronic Chalcosis may present with

• Low-grade intraocular inflammation
• Variable or no changes in visual function
• Gradual diminution of vision.

CAUSES: Copper containing foreign bodies are the most common non-magnetic foreign bodies. Copper diffuses within the eye in its ionised form. Foreign bodies containing more than 85% copper includes –  Penetrating ocular injuries, Wilson’s disease (hepato-lenticular degeneration)

 DIAGNOSIS 

Clinical features such as:

• Sclera:May show softening or abscess formation
• Cornea:There may be Kayser- Fleischer ring (usually superior and/or inferior). It may be circumferential as well.
• Anterior chamber:There may be cells and reactions. Copper- coloured metallic particles may be present.
• Iris:It may show greenish tinge.
• Lens:Sunflower cataract (chalcosis lentis) in anterior and posterior central lens capsule as a green- grey, almost metallic, disciform opacity, often with serrated edges and lateral radiations. There may be yellow or copper tinge.
• Vitreous:Greenish or reddish- brown deposits with degeneration.
• Retina:Granular deposits, retinal detachment or degeneration.
• Optic nerve:

LABORATORY TESTS

• Visual field.
• Electroretinogram.
• Dark adaptometry
• B- scan ultrasonography 
• Computed tomography 
• Radiographic spectrometry.

HOMOEOPATHIC MANAGEMENT:

MER SOL : Lids red, thick, swollen. Profuse, burning, acrid discharge. Floating black spots. After exposure to glare of fire; foundrymen. Parenchymatous keratitis of syphilitic origin with burning pain. Iritis, with hypopyon.

NUX VOMICA : Photophobia; much worse in morning. Smarting dry sensation in inner canthi. Infra-orbital neuralgia, with watering of eyes. Optic nerve atrophy Orbital twitching radiating towards the occiput, Optic neuritis.

SULPHUR : Burning ulceration of margin of lids. Halo around lamp-light. Heat and burning in eyes Black motes before eyes. First stage of ulceration of cornea. Chronic ophthalmia, with much burning and itching. Parenchymatous keratitis. Cornea like ground glass.

IOD : Violent lachrymation. Pain in eyes. Pupil dilated. Constant motion of eyeballs.