Siderosis is a complication due to a magnetic intraocular or intraorbital foreign body. Metals such as Fe and Cu, have the greatest potential for induction of siderosis. Nearly all ocular structures are involved in the siderotic process and glaucoma, cataract, iris color changes, mydriasis, retinal function destruction, and optic nerve atrophy could happen within weeks to months. This case report represents clinical course of a child with siderosis manifested as anisohyperopia.

A 1 y/o girl was referred to strabismus clinic with anisometropia and glasses intolerance. The cycloplegic refraction was +4.00,-2.00*180 (OD) and Plano (OS). On SLE, the right eye showed iris heterochromia and atrophy, ectropion uvea, posterior synechia and mild cataract. On funduscopic exam there was pale disc and vascular narrowing and retinal atrophy with pigmentary change. The left eye was normal completely.

The patient was sent for an MRI, but radiologist decided to do an x-ray. On plain x-ray, a 3mm metal was detected in intraorbital cavity (figure 1). Parsplanaviterctomy and lensectomy was done and encapsulated metal FB was removed from adjacent to optic disc. After a thorough history taking from parents whom showed very good care for baby, it was clear that 4 months ago the baby have had a nonaccidental fall on carpet at home then developed subconjunctival hemorrhage. She was referred to an academic center and evaluated but a dilated fundus exam was not carried out.

Interestingly, this case presented anisometropia months later and even with retinal examination the FB was not detected by pediatric ophthalmologist because of encapsulation. In conclusion this report highlights two important messages; first any child with any history of trauma should undergo dilated funduscopic examination at the same time. Second anisometropia with intolerance for therapy should be evaluated for underlying cause.