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.
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.
The features vary according to the size, location and content of copper in intraocular foreign body.
Acute Chalcosis presents rapidly with
- Deteriorating vision
- 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)
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:
- Visual field.
- Dark adaptometry
- B- scan ultrasonography
- Computed tomography
- Radiographic spectrometry.
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.