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Ulcerative keratitis following particulate elemental gold deposition
Akash Raj1, Geraint P Williams, Nicholas R Hawksworth
1Birmingham and Midland Eye Centre, City Hospital, Birmingham, United Kingdom. akash.raj@nhs.net
Summary
A chemical eye injury from a gold compound caused delayed ulcerative keratitis in a patient 40 years later. Topical steroids successfully treated these localized corneal erosions.
Area of Science:
- Ophthalmology
- Toxicology
- Materials Science
Background:
- Chemical eye injuries can have delayed complications.
- Gold compounds are used in various industries and can pose toxicological risks.
Observation:
- A 68-year-old male industrial chemist experienced bilateral eye injuries from a gold/amine compound explosion.
- Forty years post-injury, he developed localized ulcerative keratitis adjacent to embedded gold in the cornea.
Findings:
- Treatment with topical hydrocortisone was successful for ulcerative keratitis.
- Three subsequent episodes of keratitis were managed with topical steroids, avoiding systemic immunosuppression.
- Systemic autoimmune and vasculitic screenings were normal.
Implications:
- Exogenous gold deposition, previously considered inert, may contribute to localized, recurrent stromal erosion years after injury.
- This case highlights a novel presentation of delayed ocular toxicity from industrial chemical exposure.
- Ocular chrysiasis may manifest differently with exogenous gold deposition compared to systemic administration.
