Argyrosis of the Conjunctiva

From EyeWiki
Original article contributed by: Centrael Tyson Evans, MD
All contributors: Centrael Tyson Evans, MD and Maria A. Woodward, MD
Assigned editor: Pedram Hamrah, MD
Review: Assigned status Not reviewed by Pedram Hamrah, MD on February 17, 2017.


Argyria, derived from the Greek word for Silver (Argyros), is a condition caused by chronic exposure to chemical forms of the element silver. The most commonly recognized symptom is the dramatic blue or bluish-grey colored skin. Argyrosis is the corresponding condition related to the eye.

Disease Entity

Ocular discoloration caused by the local or systemic absorption of silver is known as ocular argyrosis. Argyrosis, any eternal bodily discoloration caused by silver, may be the visible manifestation of generalized argryria.[1] Large doses of silver were used medicinally since the 17th century in the treatment of disorders such as epilepsy. Some records exist of silver nitrate being used therapeutically in 69 BC. Therapeutic argyria is now rarely seen but occurs infrequently in the patient receiving silver-containing ocular medications such as argyrol. Ocular argyrosis has also been reported after repeated occupational exposures. Case reports exist of argyria in studio photographers and dentists. Aside from the discoloration of the eye few pathologic alterations occur with argyrosis with the most common being difficulties adapting to dark environments. Rare involvement of the lacrimal sac, lens, and cornea has also been reported. Ocular argyrosis has been reported after repeated exposure to silver-containing compounds, usually from topical silver-containing medicinal solutions [2] or occupational exposures. [1] [3] [4] [5] Argyrosis should be considered in the differential diagnosis of focal pigmented conjunctival lesions.

Etiology

As stated before, ocular argyrosis is most commonly reported after repeated exposure to silver-containing compounds. After prolonged exposure, silver is deposited into the tissues causing argyrosis.

Risk Factors

Argyrosis typically occurs in individuals with occupational exposure to silver. One article demonstrated a direct relationship between the levels of pigmentation and duration of employment. Another case report showed ocular argyrosis after long-term application of eyelash tint.[2]

General Pathology

In one case study, histologic examination demonstrated silver deposition in the basement membrane and superficial substantia propria of the conjunctiva.[2]

Diagnosis

Clinical evaluation may reveal various degrees of silver deposition on the upper eyelid, lid margin, caruncle and conjunctiva, and/or diffuse Descemet’s membrane deposits.

Diagnostic procedures

Clinical evaluation may reveal various degrees of silver deposition on the upper eyelid, lid margin, caruncle and conjunctiva, and/or diffuse Descemet’s membrane deposits.

Management

Management of this condition primarily involves prevention. Individuals with occupations that place them at risk should be protected with protective goggles.

Prognosis

Although a significant functional deficit related to ocular silver deposition has not been clearly documented, the possibility of subtle visual changes or future deficits cannot be ruled out.

References

  1. 1.0 1.1 Moss AP, Sugar A, Hargett NA, Atkin A, Wolkstein M, Rosenman KD. The ocular manifestations and functional effects of occupational argyrosis. Arch Ophthalmol. 1979 May;97(5):906-8. PubMed PMID: 312638.
  2. 2.0 2.1 2.2 Gallardo MJ, Randleman JB, Price KM, Johnson DA, Acosta S, Grossniklaus HE, Stulting RD. Ocular argyrosis after long-term self-application of eyelash tint. Am J Ophthalmol. 2006 Jan;141(1):198-200. PubMed PMID: 16387002.
  3. Hanna C, Fraunfelder FT, Sanchez J. Ultrastructural study of argyrosis of the cornea and conjunctiva. Arch Ophthalmol. 1974 Jul;92(1):18-22. PubMed PMID: 4835972.
  4. Yanoff M, Scheie HG. Argyrosis of the conjunctiva and lacrimal sac. Arch Ophthalmol. 1964 Jul;72:57-8. PubMed PMID: 14149749.
  5. Wilkes Jw. Argyrosis of the cornea and conjunctiva. J Tn State Med Assoc. 1953 Jan;46(1):11-13. PubMed PMID: 13011834.
  1. Calvery HO, Lightbody HD, Rones B: Effectof some silver salts on the eye. Arch Ophthalmol25:839-847, 1941.