Sir,

An asymptomatic 50-year-old white man was referred for corneal evaluation by his optician. His past medical history was positive for rheumatoid arthritis involving knee, hip, and small joints of the hand (Figure 1a). Control of arthritis required indomethacin (75 mg b.i.d.), maintenance dose of oral prednisolone (5 mg once daily), and more recently methotrexate (7.5 mg/week). In addition, he was receiving intramuscular injections of colloidal gold (50 mg) every alternate week since 1980. He had undergone hip and knee replacement surgery in 1990s because of joint deformity. On external examination, he had slate-grey complexion. Corrected visual acuity was 20/20 OU. On slit-lamp examination similar findings were evident bilaterally. Fine-scattered yellow-brown deposits could be seen on the central corneal epithelium. In the deep central corneal stroma, the deposits were confluent (Figure 1b). The lens was clear. Ophthalmoscopic examination was normal.

Figure 1
figure 1

(a) Typical rheumatoid deformity of the hands. (b) Slit-lamp photograph showing yellow-brown confluent deposits in the deep corneal stroma.

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Comments

The term chrysiasis is derived from the Greek ‘chrysos’ referring to effects of gold on various tissues most noticeably recognized in the skin, which may show colour changes ranging from a periorbital mauve/blue to a diffuse slate-grey/blue appearance.1 Widespread deposit of gold occurs in patients who have received a cumulative dose greater than 1 g.2 Deposition of gold in ocular structures, particularly in the cornea, is termed ocular chrysiasis.3 Corneal deposits can be limited to the epithelium4 or the stroma.2 Deposition in the lens occurs infrequently.5 On histopathologic evaluation, gold deposits are present both intracellularly and extracellularly without any inflammatory reaction.3 Colloidal gold therapy is effective in slowing the progression of rheumatoid arthritis and therefore patients who respond favourably are usually kept on maintenance therapy for many years.6 Occurrence of ocular chrysiasis does not require discontinuation of gold therapy.