OCULAR CHALCOSIS ROBERT VON DER HEYDT, M.D.
This paper describes the impregnation of ocular tissues with metallic copper derivatives. Certain limiting areas show a predilection for storing copper salts. In the cornea a deposit forms near Descemet's membrane adjacent to the limbus. In the lens a faint subcapsular sunflower disc is seen behind the anterior capsule. The vitreous supporting structure may also be impregnated. Stereophotographs illustrate these three areas of deposition. Read before the Chicago Ophthalmological Society, March 18, 1935.
There is an abundance of ophthalmic literature describing chalcosis. In con-. nection with an article by Weiss appearing in "Graefe's Archiv," in 1926, a bibliography of eighty-six articles is given. Injuries sustained during the war have added to the many recorded observations of this interesting and peculiar type of copper impregnation of ocular tissues.
Chemically, chalcosis presents a copper and carbonic acid combination producing a basic copper carbonate. According to Leber, the ocular fluids dissolve the metal and it is then diffused through the tissues. The normal interchange of fluids allows of and favors a deposition of copper particles on limiting ocular membranes. Therefore we find characteristic copper deposits in certain areas on the posterior cornea, under the anterior lens capsule, and in the vitreous.
The cornea. The copper-salt impregnation is manifested mainly in the limbus zones by a faint greenish, bluish, or grayish deposition in the vicinity of Descemet's membrane. A similar deposition of endogenous organic pigment is found in Wilson's disease (pseudoscler-osis or hepato-lenticular degeneration) and is then called a Kayser-Fleischer ring.
In this disease, because of copper intoxication, the cornea is primarily involved and the lens may later develop a disciform anterior subcapsular cataract. In chalcosis due to copper deposition within the eye because of ocular injury, a reverse sequence is observed.
The lens. "Sunflower cataract." Purtscher first described the change
in the anterior subcapsular lens zone as a "Schein-Cataract" meaning a cataract just faintly apparent and often allowing normal visual acuity.
Jess states that the copper is deposited in the anterior subcapsular area in the form of a flat sunflower-shaped disc, between the capsule and the lens epithelium. Vogt has shown histologically that the substratum of the sunflower cataract is mainly in the lens epithelium. The cell stroma harbors the copper, while the nuclei are not involved. This peculiarity may be the cause of the characteristic, faint, uniform, bronze-colored punctation as seen with the slit-lamp. If the layer of copper is thin it presents a greenish iridescence. A greater quantity of copper is manifested by a reddish, metallic, copper color and a faint greenish iridescence in the clear lens zones, especially in cases of long standing.
According to Jess, the peripheral radial striations of the sunflower design are found in the interspaces between the radial iris folds. Vogt claims they are directly under the iris folds and due to trauma produced by movement of the iris.
The vitreous. An opacification of the vitreous may occur due to faint dustlike particles. The delicate supporting structure is covered with reddish, metallic, bronze-colored granules. Apparently there is no deep penetration into the vitreous body.
The patient I have studied gives the following history:
Miss F. M., in her early twenties, had a piece of copper wire enter the eyeball three-and-a-half years ago, Several small pieces were supposed, to have been removed. No copper foreign body is visible now. The eye is free of irritation. I find a minute black dot in the sclera just behind the ciliary body at "11 o'clock," which was probably the site of entry. The posterior vitreous seems clear and the retina uninvolved.
OCULAR CHALCOSIS 1047
The cornea, especially in the upper part, presents a 2.5-mm.-wide, flat, band-shaped Kayser-Fleischer-ring deposition along the limbus at the Des-cemet's area. The infiltration is grayish and in appearance like a thin piece of extremely fine lace. The meshwork is composed of rounded black holes, the larger nearer the limbus, and very minute openings toward the center of the cornea. The appearance is quite different from corneal argyrosis found at this depth. In argyrosis there is a faint, uniform, floral, wallpaperlike pattern.
The lens shows a typical, flat, sub-capsular, uniformly granular, dustlike infiltration of a dull, metallic, copper-bronze colorjust like a newly minted penny. The clear lens zones show a faint greenish fluorescence. That the deposit is subcapsular is plainly visible. That it must be within the lens epithelium is shown by the fact that the disc
is still directly under the capsule, though the process is over three years old. The newly apposed fibers must lie posterior to the disc. Were the deposit of copper within the subcapsular lens fibers, the disc would by this time have been displaced visibly inward by the interposed newer fibers.
The anterior-vitreous structure is uniformly encrusted with bronzelike, metallic copper particles. Evidently this infiltration is -confined to the anterior vitreous, as the fundus is fairly visible with the ophthalmoscope. The visual acuity is 20/50 and normal with glasses, in spite of the deposition of copper in the lens and vitreous.
I have succeeded in making stereo-photographs of the copper as it may be seen stored in the cornea, lens, and vitreous.
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