Siderosis &chalcosis & IOFB

One of the untouched topic in IOFB, will help u guys who r stuck with finding presentstion on this topic. #each one teach one series

1. IOFB LOCALISTAION SUMMARISED

2. ELECTRICAL METHOD OF LOCALISATION BURMAN LOCATOR ROPER HALLS LOCATOR CARNAYS LOCATOR OPHTHALMOMETTALOSCOPE OF HALE

3. IMAGING TECHNIQUES DIRECT RADIOGRAPH METHOD GEOMETRIC RECONSTRUCTION Sweet`s Method Mackinzie Method Dixon Method LIMBAL RING TEST CONTACT LENS METHOD COMBERGS METHOD WORST LOVAC CONTACT LENS

4. SIDEROSIS & CHALCOSIS Siderosis Bulbi is PIGMENTORY & DEGENRATIVE change in foreign body containning iron. Pathological Anatomy first described by Von Hippel (1894). Suggested 2 types of Siderosis :- 1.Haematogenous 2.Exogenous.

5. Corrosion is the destruction of a metal resulting from its contact with a liquid. Factor which increase the velocity of corrosion are presence of oxidizing agents , uneven surfaces of the metal , higher temperature & greater alkalinity . Human eye offers an optimal situation for corrosion.

6. HOW IRON AFFECTS?? Chemical process in ocular siderosis have been debated for years. Von Graefe (1860) thought that iron diffuses in form of oxides. Leber (1882) thought iron bicarbonate is formed, which is oxidized and pecipitated in ocular tissue. Friedenwald (1954) believed that stainning of tissues by iron is due to to ferric ions in low concentration which combine with sulph-hydryl groups in the cells. AAO writes that Oxidation & dissemination if Ferric ions throughoput the eye promotoes Fenton reaction,which leads to formation of Hydroxyl ions. These hydroxyl ions causes Lipid peroxidation , sulfhydryl oxidation & depolymerization with cell membrance damage & enzyme inactivation.

7. PATHOLOGY Epithelium of ciliary body is the first tissue affected and the non-pigmented epithelium stains earlier. Iris is affected at the anterior limiting layer & in the sphincter & dilator muscles. Macrophages laden with iron pigments are commmonly found in trabecular meshwork. RPE is invariable affected . The ganglion cells are involved & macrophages laden with pigment surround the retinal vessels.

8. !!!INTERESTING !!! The site of foreign body governs both the rate and extent of tissue stainning . Process is rapid when the metal is bathed in ocular fluids and slow when it lies in tissues of low metabolism such as lens & cornea. Rupture of lens capsule & bruschs membrane facilitates the disruption of iron.

9. CLINICAL FINDINGS

10. SYMPTOMS Nyctalopia *(Early Symptom) Decreased Vision Concentrically constricted visual field. SIGNS Pupillary mydriasis & poor reactivity.* (Earliest sign) Rust coloured corneal stainning at entry points. Iris hetrochromia (as more iron deposit in musculature of iris) Brown deposit on anterior lens. Cataract (only if penetration is there) Vitreous opacities Peripheral retinal pigmentation (Early) Diffuse Retinal Pigmentation (Late) (appearance confused with RP) Narrowed Retinal Vessels Optic disc discoloration & atrophy Secondory open angle glaucoma from iron accumulation in trabecular meshwork.

11. INVESTIGATIONS Slit lamp Photo & Fundus Photo B-Scan ERG CT Scan X-Ray

12. INVESTIGATIONS

13. Full-field ERG is the most common means for detecting OS and all patients should have this prior to surgical intervention . Iron retinotoxicity leads to a dysfunction of all the layers of the retina with more severe damage occurring in the inner retina than in the outer retina in the late stages of the disease . In the early phase, both the a-wave and the b-wave, though more commonly the former, can be transiently increased. As siderosis progresses, the b-wave decreases, causing the b-wave/a-wave ratio to fall. Rod-dominated responses are predominantly affected as they have a greater susceptibility to iron toxicity compared to the cone system . Improvement in ERG with removal of an IOFB has been documented by several autho

14. CHALCOSIS

15. HISTOPATHOLOGIC < 85 % COPPER CHALCOSIS ACUTE (<= 3 WEEKS) CHRONIC (1OR MORE YEAR) >85 % COPPER DUKE`S ELDER SUPPURATIVE CHRONIC NON GRANULOMATOUS REACTIVE FIBROSIS DISSEMMINATED COPPER DEPOSITION

16. Tend to deposit in Basal Layer as compared to siderosis which preferred epithelial layer. IOFB with high copper content involves violent endophthalmitis often with progression to phthisis bulbi Alloys with low copper content like brass and bronze results in chalcosis Kayser -Fleischer ring is golden brown ring which occurs due to deposition of copper under peripheral part of Descemet’s membrane of the cornea  Sunflower cataract produced by deposition of the capsule under posterior capsule of the lens.Brilliant golden green in colour 

17. Retina – deposition of golden plaques at the posterior pole which reflects light with a metallic sheen  Degenerative retinopathy does not develop as it is less retinotoxic compared to iron

18. INVESTIGATIONS Slit lamp Photo & Fundus Photo B-Scan ERG CT Scan X-Ray

19. TREATMENT SIDEROSIS Remove the FB Galvanic deactivation. Administration of IV EDTA. Sub.Conj injection of ATP Administration of Desferrioxamine which traps free ions & converts into non-toxic chelate. CHALCOSIS Remove the FB Sodium Thiosulphate BAL (British Anti- Lewsite )

20. Pathology of eye trauma is of immense interest as many of the changes in the eye and adnexa are different from the pathology of other part of the body . An understanding of the nature of activity of different FBs are important for medico legal purposes and in determining its nature, need for urgent removal. HOW MANY OF U AGREE TO THIS POINT???

21. In this series , most of the iron FBs which had larger size caused significant damage to the structures, consistent with other studies . I ron FB lodged in crystalline lens caused microscopic changes in the lens capsules and the adjoining areas. Retinal pigment epithelium (RPE) showed degenerative changes with iron FB. Copper FB was seen and documented in SEM and EDX .Pure copper usually produces a suppurative reaction and alloys of 80% copper or less may subsequently lead to chalcosis Zinc and aluminum IOFBs are toxic and should be removed immediately It is always urgent and mandatory to remove the vegetable IOFBs because they usually contain microorganisms that can lead to endophthalmitis and cause excessive inflammation . Glass and plastic IOFBs are often well tolerated; they may be retained indefinitely in many cases if there is no surrounding damage and if it is immobile . In some cases, stone fragments may be well tolerated but the risk of seeding with micro-organisms merits their prompt removal Sympathetic ophthalmia is characterized by granulomatous pan-uveitis following penetrating injuries of the globe which can be accidental or surgical.

22. Wound length is predictive of the risk of retinal injury. A small external wound is suggestive of retinal damage as less of the IOFBs energy is dissipated during penetration, allowing it to reach and injure the retina . Foreign bodies entering the eye through sclera are more damaging than the corneal wound of entry . Retained IOFBs exhibit long-term toxicities like siderosis and chalcosis which may lead to retinal pigmentary changes and retinal toxicities as seen in our pathological samples

23. WHAT,IF U WERE THERE AT GMCH ,KASHMIR!!!! MANAGEMENT OF IOFB

24. Video

25. BRONSON ELECTROMAGNET.

26. LANCASTER WORKING CRITERIA FOR A MAGNET It states that to be EFFECTIVE , A giant Magnet should pull steel bale of 1mm diameter with a force of over 50 TIMES its weight at a distance of 20mm

27. REFERENCES Management of Ocular Siderosis : Visual Outcome and Electroretinographic Changes Naresh B. Kannan , Olukorede O. Adenuga , Renu P. Rajan , and Kim Ramasamy . SIDEROSIS BULBI * BY J . F. BALLANTYNEt From the Department of Ophthalmology, University of Toronto. Brit. J. Ophthal. (1954) 38, 727 . Das D, Misra DK, Bhattacharjee H, Kapoor D, Deka H, et al. (2017) Pathological Significance of Ophthalmic Foreign Bodies. Adv Ophthalmol Vis Syst 7(3): 00225. DOI: 10.15406/aovs.2017.07.00225 Chalcosis in the Human Eye A Clinicopathologic Study\ Narsing A. Rao , MD; Mark O. M. Tso , MD; A. Ralph Rosenthal, MD Pictures from Google search engine . Ryan 6th edition Intraocular Foreign Body management. FAQ in ophthalmology. Thanks DR.AMU & DR.DIVAKANT SIR for inputs..

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