The Montgomery Lecture, 1979. Ocular metallosis

'Redox processes' and complex biochemical formations offer a simple key to understanding metallotic damage to the eye. Various factors determine the timing and severity of this damage. Siderosis is a process with a chronic course. In a large group of patients with copper-containing foreign bodies the majority showed a more acute course. In the past, the relatively rare cases of chronic chalcosis without fibrotic reactions in the vitreous determined the text book descriptions familiar to our fathers. In our series of 282 cases of copper-containing foreign bodies in the vitreous, the chalcosis took a subacute, acute, or fulminating course in 68 per cent, and only half of the other 32 per cent represented time chronic chalcosis. In 18 per cent the injury was recent and the cellular reaction was only just beginning. Cellular reactions, especially fibrosis, are the chief characteristics of acute chalcosis. Vitrectomy permits the surgical treatment of eyes with severe vitreous fibrosis and retinal detachment, but because these eyes are in the pre-phthisic stage, a fair number of successes is counterbalanced by an increasing number of enucleations.