Purpose:
To document a very rare and only reported case to our knowledge that looks at pan-ocular findings and utilizes diagnostic tests including fluroscein angiography in a patient with chronic silver nitrate salt ingestion for purposes of water disinfection.
Methods:
Observational case study.
Results:
86 yo Caucasian male who presented for evaluation of decreasing vision and nyctolapia for the past 2 years in both eyes. Patient was recently diagnosed with cutanious argyrosis secondary to chronic ingestion of silver nitrate salts. On exam patient’s appearance was striking for generalized grey-bluish hue to the skin especially face. Patient’s BCVA acuity was 20/40 right eye and 20/50 left eye. Both palpebral and bulbar conjunctiva had purple-blue hue. Both corneas were clear with no corneal opacities. Mild bilateral cataracts were present. On funduscopic exam patient had notable retinal pigment epithelial changes and drusen in both of the maculas. Fluroscein angiogram (FA) was obtained and showed striking feature of choroidal blockage throughout all the phases representing completely dark choroid in both eyes. Additional tests were obtained which included fundus autofluorescence (FAF), spectral domain OCT, and ERG.
Conclusions:
Silver nitrate is soluble salt that mostly used in industry nowadays. Our patient has been ingesting silver nitrate salt as part of homeopathic remedy for water purification for 13 years. In the literature there have been multiple reports describing only anterior segment findings in patients with chronic occupational exposure to silver compounds or use of topical or oral medications containing mostly colloidal silver. Only one case series out of France described 6 patients with findings of dark choroid on FA and those patients used medications which contained colloidal silver. This case is the first case to be reported where patient was self ingesting silver nitrate salts and showed striking signs of systemic argyrosis with pan-ocular involvement including most interesting feature which was observed on fluroscein angiogram of completely dark choroid.
Keywords: drug toxicity/drug effects • choroid • imaging/image analysis: clinical