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Wilson’s Disease: Ophthalmic Manifestations

Jonathan A. Barnett

  • The two classic ophthalmic manifestations of Wilson’s disease are the “Kayser-Fleischer ring” (copper deposition around the corneal limbus) and the “Sunflower cataract” (copper deposition in the lens).

  • Wilson’s disease rarely affects vision (unless the sunflower cataract is very advanced).

  • Unless the disease is very advanced/has been present for years, it is impossible for one to detect subtle copper deposition in the cornea, iridocorneal angle, or lens without an office-based slit lamp exam and gonioscopy (only available in the outpatient setting).

    • Furthermore, the presence or absence of a Kayser-Fleischer ring does not rule in or rule out the disease

    • Testing for decreased ceruloplasmin, urinary copper levels, and genetic testing are more effective diagnostic methods.

  • If concerned about the visual impact of a developing sunflower cataract, an outpatient ophthalmology referral is appropriate.