A 39-year-old man developed ocular siderosis months after an intraocular foreign body (IOFB) entered the eye during trauma from hammering metal. He presented to the emergency department with progressive blurry vision in the right eye 4 months after initial trauma, and examination disclosed an IOFB in the vitreous. Electroretinogram demonstrated an increased a-wave and decreased b-wave, consistent with ocular siderosis. He underwent vitrectomy and IOFB removal, with resolution of symptoms. Five months later, the patient developed a siderotic cataract in the same eye, and slitlamp examination showed rust-colored metal deposits on the anterior capsule and posterior subcapsular cataract of the right eye. The patient underwent a successful cataract surgery, and his vision returned to baseline. This case highlights an uncommon complication of IOFBs, the variable timeline and manifestations of siderosis, and the possibility of an underlying chemical process determining the visual pattern of the siderotic cataract.
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