'Black cornea' after long-term epinephrine use
P. K. Kaiser, R. Pineda, D. M. Albert and J. W. Shore
Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston.
Fifteen years after a partial maxillectomy and radiation therapy for left
antral carcinoma, a 53-year-old woman presented to the Eye Plastics and
Orbit Service of the Massachusetts Eye and Ear Infirmary, Boston, with
phthisis and a large, black corneal lesion in the left eye. She had been
treated for unilateral glaucoma in the left eye for more than 10 years with
topically administered epinephrine borate, timolol maleate, and pilocarpine
hydrochloride. Clinically, the lesion was smooth, black, and homogeneous,
and was thought to represent uveal prolapse covered by a thin layer of
epithelium. An eyelid-sparing anterior exenteration was performed.
Histopathologic examination revealed an acellular, homogeneous substance
that stained positively with the Fontana Masson stain for melanin and
bleached with potassium permanganate, findings consistent with corneal
adrenochrome deposition. Since adrenochrome can be easily dissected free
from the cornea, this case illustrates that misdiagnosing adrenochrome
deposition may lead to unnecessary surgery.
