A Quiet Masquerader: Ocular Siderosis Mimicking Chronic Uveitis and Retinal Detachment

To describe two cases of ocular siderosis caused by occult metallic intraocular foreign bodies that initially presented with misleading clinical features and resulted in diagnostic delay.

A 30-year-old man was referred with presumed chronic unilateral uveitis that had been treated with corticosteroids for nearly one year without improvement. Ocular examination revealed mild cataractous changes, brownish spots on the anterior lens capsule, subtle endothelial iron deposition, and posterior segment abnormalities, including retinal pigment epithelial alterations, vascular attenuation, and characteristic optical coherence tomography findings suggestive of chronic siderotic retinal injury. Orbital computed tomography confirmed a retained metallic intraocular foreign body. A 35-year-old man presented with a markedly different clinical presentation characterized by severe visual loss and dense vitreous haze. B-mode ultrasonography revealed marked vitreous condensation and findings suggestive of a shallow retinal detachment, while anterior segment examination demonstrated subtle findings suggestive of previous occult ocular penetration, including a limbal scar, iris irregularity, corneal stromal deposits, and faint lenticular pigmentation. Orbital computed tomography identified a retained metallic intraocular foreign body in the inferior aspect of the right globe.

Ocular siderosis may remain unrecognized when a history of ocular trauma is absent and clinical findings are subtle, atypical, or misleading. Ocular siderosis should be considered in patients with otherwise unexplained inflammatory or vitreoretinal abnormalities, even in the absence of clear signs of penetrating injury. Early recognition and appropriate imaging are critical to avoid diagnostic delay, unnecessary treatment, and irreversible visual loss.