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Asteroid hyalosis of the vitreous humor: An uncommon finding

Dear Dr. Bedrossian, Asteroid hyalosis is an uncommon condition affecting the vitreous compartment of the eye. It was first described by Benson in 1894. Historically, it was called asteroid hyalitis as it was thought to occur as part of an inflammatory process; however, the name was later changed to asteroid hyalosis when it became apparent that the process was degenerative. Other historical names for the condition include Benson’s disease, asteroid bodies, and scintillatio nivea. Asteroid hyalosis is more commonly seen in patients in their seventh to eighth decades, and more frequently occurs in males. It is unilateral in most instances, but approximately 10–25% of cases show bilateral involvement. Associations with coronary artery disease, gout, and smoking have been postulated, but no consistent correlations have been shown. In an autopsy case series of 10,801 eyes, the authors found asteroid hyalosis strongly correlated with age, male sex, and posterior vitreous attachment, and found no correlation with diabetes mellitus. A Korean study found stroke history to be the strongest risk factor associated with asteroid hyalosis. Asteroid hyalosis generally does not cause visual symptoms. Clinically, it is diagnosed either by retinal photography or by slit lamp examination, which disclose opaque, iridescent particles that follow eye movement. Recently, others have published findings of abnormal vitreoretinal adhesions detected preoperatively using optical coherence tomography; this may be helpful for clinical diagnosis when asteroid hyalosis is suspected. Histochemically, asteroid hyalosis bodies stain strongly positive for mucopolysaccharides by alcian blue or colloidal iron stains and weakly positive by Oil-Red-O staining. Chemically, the asteroid bodies are composed predominantly of calcium and phosphorus, which are bound to ribbons of complex lipids. Although the pathogenesis of asteroid hyalosis is not well understood, the large quantities of complex lipids and calcium forming the asteroid bodies have been hypothesized to derive from sources exogenous to the vitreous. We report a case of an 82-year-old female who initially presented to her general ophthalmologist with a complaint of decreasing visual acuity in her left eye. Her past ocular history included previous cataract surgery and macular degeneration. Over the preceding several months, her visual acuity had declined from 20/70 to finger counting only in the left eye. The referring ophthalmologist noted a dense vitreous haze consisting of multiple discrete opacities, which had worsened progressively, coinciding with