Overview
Subpial siderosis refers to iron deposition within ocular tissues, often resulting from trauma involving iron particles, leading to progressive ocular complications including corneal perforation and intraocular damage. 12Diagnosis
Clinical Presentation: Impaired vision, corneal perforation, cataract, retinal pigmentary degeneration, iris heterochromia, pupillary mydriasis, secondary glaucoma, and relative afferent pupillary defect. 2
Histopathologic Findings: Prussian blue staining indicating ferric ion penetration into the corneal stroma and Descemet's membrane. 1
Diagnostic Imaging: Slit-lamp biomicroscopy and anterior segment optical coherence tomography (AS-OCT) for initial assessment; histopathology for definitive diagnosis. 1Management
Surgical Intervention: Penetrating keratoplasty for corneal perforation and surgical removal of intraocular foreign bodies (IOFBs) when present. 12
Supportive Care: Antibiotic therapy and therapeutic soft contact lenses for initial management of corneal injuries. 1
Monitoring Complications: Regular follow-up to manage secondary complications such as cataract, glaucoma, and retinal degeneration. 2Special Populations
Delayed Presentation: Common in patients due to delayed recognition or reporting of ocular injuries, particularly affecting management outcomes. 2Key Recommendations
Perform histopathologic examination using Prussian blue staining to confirm ferric ion deposition in suspected cases of subpial siderosis. (Evidence: Moderate) 1
Utilize the Ocular Trauma Score (OTS) to predict visual outcomes and guide management strategies in patients with siderosis bulbi and retained IOFBs. (Evidence: Moderate) 2
Early surgical intervention, including corneal transplantation and IOFB removal, is crucial for preventing further ocular damage and improving visual outcomes. (Evidence: Expert opinion) 12References
1 Kato K, Hirano K, Takashima Y, Sakamoto S, Kondo M. Histopathologic findings of perforated corneas due to ferric ion infiltration. Canadian journal of ophthalmology. Journal canadien d'ophtalmologie 2015. link
2 Zhu L, Shen P, Lu H, Du C, Shen J, Gu Y. Ocular Trauma Score in Siderosis Bulbi With Retained Intraocular Foreign Body. Medicine 2015. link