Corneal Copper Deposits in a Breast Cancer Survivor: A 5-Year Follow-Up

This article aims to describe an extremely rare case of corneal copper deposition due to elevated IgG levels following systemic malignancy.

Case report of a 49-year-old woman with a history of breast cancer treated with radiation therapy, tamoxifen, and gonadorelin, who presented in 2019 for asymptomatic "color change" in both eyes.

Slit-lamp biomicroscopy, disclosed central golden-brown corneal deposits at the level of Descemet's membrane, indicative of copper accumulation. During a 5-year follow-up, deposits increased in density and extended peripherally, while visual acuity remained 20/20 bilaterally. Normal ceruloplasmin, liver function tests, and urine copper levels ruled out Wilson's disease. Elevated IgG kappa levels suggested an underlying monoclonal gammopathy. The patient was referred for a hematologic evaluation but declined further testing.

Only a limited number of cases with central corneal copper deposits have been described in the literature, all of which are associated either with multiple myeloma or with monoclonal gammopathies of unknown significance. Presumably the copper binds to alternated IgG with high affinity and the accumulated copper is deposited in the central Descemet's membrane. Recognizing this characteristic clinical appearance is essential, as it may indicate an undiagnosed hematologic disorder requiring systemic evaluation.