Who are you going to believe, me or your own eyes?

[KeithTaylor]

Here's one for the “it can't be gout if your toe doesn't hurt” brigade.

?

I was surprised today when I spotted “Subconjunctival urate crystals: a case report.” I almost scanned past it, but a part of my brain registered that it sounded like something to do with eyes. Sure enough:

Abstract

PURPOSE: To report a case of localized subconjunctival urate crystals in a patient with gout.
DESIGN: Single observational case report.
METHODS: Case report.
RESULTS: An 80-year-old woman who came for cataract surgery was incidentally found to have subconjunctival crystal deposits near the superior limbus in her left eye (OS). She was taking medications for gout and hypertension. Multiple conjunctival crystals were excised from the area before cataract surgery. Light microscopy under polarization revealed crystals, and histopathological examination confirmed gouty tophi.
CONCLUSION: Because subconjunctival urate crystals occur only rarely, ophthalmologists should be aware of this potential, particularly in patients with gout.

And that abstract had a link to a similar case in 2005, that time with a 59 year old woman with a 25 year history of gout. So I searched further, and apparently it is not uncommon.

Optometry.com lists several links with different parts of the eyes and gout:

GENERAL
One of many arthritic disorders that affect the eyes. It is a genetic disease of purine metabolism and renal excretion of uric acid.
OCULAR SIDE EFFECTS & SYMPTOMS

• EOM? tenonitis, ocular motor disturbances
• LID? blepharitis
• CONJUN? conjunctivitis, pinguecula, red eyes
• CORNEA? crystalline deposit
• SCLERA? episcleritis, posterior scleritis
• IOP? elevated (open-angle glaucoma)
• IRIS? iridocyclitis
• VITREOUS? opacities, asteroid hyalosis
• RETINA? exudative detachment

I'm wondering if my own inability to wear contact lenses for more than a few hours before becoming cloudy is associated with gout?

Finally, it wouldn't be GoutPal without a gulp-inducing picture, so the squeamish should look away now (actually, it's quite mild judging by some of the recent contributions) ?

The patient, a 54-year-old man with longstanding untreated gout, developed progressive redness of both eyes, with an ocular burning sensation and visual disturbance. Ophthalmologic examination revealed hyperemia of the conjunctival and episcleral vessels and multiple chalky deposits on the corneal stroma. Polarized light microscopy examination of a scraping from a deposit revealed typical monosodium urate monohydrate crystals. The patient's serum uric acid level was 600 ?moles/liter (normal 223?487). The patient was treated with allopurinol and colchicine, with significant clinical improvement.

600 ?moles/liter is approx 10mg/dL

More gout photographs and images in the Gout Picture Library

[hansinnm]

Thanks again, Keith.

“Who are you going to believe, me or your own eyes?”

I believe you and my own eyes. Lucky for me, I had a thorough eye examination this last Thursday, including two special eye tests(forgot the names) and I am pretty sure that I don't have any gouty eyes. Another reason to get solid 8-9 hours a night sleep.?

[zip2play]

OH…MY…GOD!

?

Is there ANYPLACE urate won't deposit?

?

I guess it's logical because the outer surfaces of the eyes must get quite cool in Winter.

[trev]

Funny how urate, chloresterol and even haemachromisasis can put deposits in the iris.

[NB: Optic nerve is brain tissue].

Makes me ask- is urate deposition involved in Alzheimers?- it's gettting so common, just like gout is increasing…

[odo]

trev said:

Makes me ask- is urate deposition involved in Alzheimers?- it's gettting so common, just like gout is increasing…

---

No, it's protein deposits rather than urate.

[trev]

I realise that, but I remembered some connection and checked- it's a positive one, like for MS- and SUA? being high in these cases is a 'good thing'!

Maybe as all the 'bad'?protein gets mopped up in the brain?- as urates grab the action?

[odo]

Sounds eminently plausible Trev. Seems like the body does its best to lay down deposits of crud wherever it can

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