This occurs in patients with rheumatoid arthritis or other autoimmune disease treated with gold salts.
Features:
(1) The deposits first appear in the cornea as yellowish-brown to purple-violet granules. The most common site is the deep stroma but they may occur throughout the cornea. They may also occur in the corneal epithelium, usually in a vortex distribution.
(2) The cornea may appear purple on cross-illumination.
(3) The patient does not have any deterioration in visual acuity and is usually aymptomatic unless hypersensitivity develops (see below).
The corneal deposits are dose and duration dependent.
(1) Typically the patient has received 1 gram or more of the gold salts, and the deposits increase as the cumulative dose increases.
(2) If the person has received gold therapy for more than 36 months, then deposits may also occur in the lens.
(3) The deposits gradually disappear once the drug is discontinued.
Some patients develop a hypersensitivity reaction to the gold salt, which can result in a marginal ulcerative keratopathy. This is treated by stopping the gold therapy and administering penicillamine.
