Multifocal corneal argyrosis after an explosion injury

Purpose. To document the clinical and histopathologic corneal features of a patient who developed multifocal corneal argyrosis after a chemical explos ion injury with unusual involvement of the corneal stroma and keratocytes. Methods. The corneal button was investigated by light and transmission elec tron microscopy and scanning electron microscopy combined with energy-dispe rsive x-ray microanalysis. Results. Clinically, the patient showed dark dis coloration of the lids, periocular skin, episclera, and conjunctiva and had multiple brown dots in the superficial layers of the cornea. Microscopic e xamination of the comes showed diffuse deposition of silver particles in th e epithelial basement membrane, Bowman's layer, and Descemet's membrane. In the corneal stroma, silver granules accumulated intracellularly within lys osomal structures of degenerative keratocytes and extracellularly in associ ation with collagen fibers and cellular debris. Energy-dispersive x-ray ana lysis showed peaks of silver and sulfur. Conclusion. The toxic influence of intracellular accumulation of silver in stromal keratocytes may lead to ce ll damage and necrosis and result in visual impairment.