SUMMARY A patient is presented who had unrecognised Wilson's disease. He had developed a clinically obvious Kayser-Fleischer ring in only one eye. The eye without the corneal ring had been injured in childhood and had a low intraocular pressure. Possible mechanisms for formation of a Kayser-Fleischer ring are reviewed and the lack of Kayser-Fleischer ring in this case is discussed.
Case historyThe patient first noticed a slight tremor of his hand and slight unsteadiness of gait at the age of 35. These symptoms progressed very slowly, and he was first seen by a neurologist at the age of 52. Signs present at that time were unsteadiness, cerebellar dysarthria, and ataxia of the hands, the right more than the left. The right eye was blind and divergent, the result of a penetrating injury by a dart at the age of 7.His past medical history revealed an episode of jaundice as a teenager and a urinary infection at the age of 40. Relevant family history was that his identical twin brother had died of hepatitis at the age of 47. He had also suffered from ataxia of a similar severity.Heredofamilial ataxia was diagnosed.