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Abstract #8104 Published in IGR 4-3
Heavy iridocorneal angle hyperpigmentation and glaucoma associated with fluorosis
Aytuluner E; Mensiz EJournal of Toxicology – Cutaneous and Ocular Toxiclogy 2002; 21: 203-212
Endemic fluorosis is a chronic crippling skeletal and dental disease caused by ingestion or inhalation of large amounts of fluoride. Although the prevalence of this disease has decreased considerably, it still occurs in some parts of the world. The authors' province of Isparta is a naturally-occurring endemic fluorosis area. The aim of this study was to investigate the ocular manifestations of the disorder in a group of patients with fluorosis. Fifty (32 females, 18 males) consecutive patients, with ages ranging between 29 and 74 years (54.44 12.28), and with endemic fluorosis constituted the study group. Age and sex matched 50 consecutive patients without clinical findings of fluorosis who were selected as controls. Patients with and without fluorosis underwent a routine ophthalmological examination. To assess the levels of hyperpigmentation in anterior chamber angle, the authors constituted a grading system (from 1 to 4), based on selected brownish colors from Pantone® Color Formula Guide. The differences between two groups with respect to serum, urine, and water fluoride levels were statistically significant (for all p < 0.001). With respect to iridocorneal angle hyperpigmentation (ICA HP) grades, the difference between fluorosis and control group was statistically significant (p < 0.001). In the fluorosis group, the authors observed eight cases (16%) of open-angle glaucoma (OAG). Remarkably, ICA HP grade was 4 + in six of eight cases; this finding was statistically significant (p < 0.001). The remaining two showed grade 1 + ICA HP. Difference between number of cataracts or previous cataract operations of the two groups (fluorosis group: 15 cases (30%), controls: 12 cases (24%)) was not statistically significant (p > 0.05). The authors suggest that a heavy trabecular hyperpigmentation appearance may be a feature of endemic fluorosis. This disorder should be kept in mind in differential diagnosis of pathologic trabecular hyperpigmentation in patients with fluorosis and without the causes and symptoms of iris pigment dispersion. They also propose that endemic fluorosis may lead or augment the severity of glaucoma. Further studies are warranted in order to comprehend the exact mechanism of trabecular changes in patients with endemic fluorosis.
E. Aytuluner, MD, Department of Ophthalmology, Suleyman Demirel University School of Medicine, Isparta, Turkey. eaytoluner@ttnet.net.tr
Classification:
9.4.15 Glaucoma in relation to systemic disease (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders)
