To report a rare case of exogenous ocular gold deposition in both eyes.

Case report

A 27-year-old man whose occupation was goldsmith presented to the emergency room 2 hours after trauma. He had a history of accidental injury to both eyes while converting gold bullion to gold salt that accidentally overheated, leading to a sudden gold–amine compound explosion. The corrected distance visual acuity (CDVA) was counting fingers in the right eye and light perception in the left eye. External examination revealed edematous lids that were lacerated to the lid margins superiorly in both eyes. On slitlamp examination, the cornea in the right eye had a partial-thickness laceration and in the left eye, a corneal perforation with prolapsed iris. In the left eye, the pupil was distorted and the anterior lens capsule was disrupted with prolapsed vitreous into the anterior chamber. Golden-brown diffusely confluent metallic luster deposits similar to a galaxy were seen in the deep stromal layer near Descemet membrane in both eyes, as well as gold deposition on the limbus, conjunctiva, and sclera. On day 1 of admission, immediate and prolonged irrigation was performed with normal saline followed by foreign-body removal, corneal surface remodeling, and lid repair in the right eye; corneal repair followed by anterior vitrectomy, iris repositioning, and lid repair was done in the left eye. Two weeks later, a lensectomy and foldable intraocular lens implantation in the sulcus was done in the left eye. Four months later, the remaining granular golden-brown shiny pigmented deposits caused a severe diffuse corneal opacity. Visual acuity was not improved and remained hand motion in the right eye. The LP in the left eye was due to macular scar formation. At 8 months, penetrating keratoplasty was performed in the right eye. After follow-up of 1 year, the patient was asymptomatic and the CDVA had improved to 5/10 in the right eye.

Although gold is safe and inert, it can lead to sacrifice of eyesight. Immediate and prolonged irrigation followed by proper management is essential for patients who present after acute injury.