A case report of ochronosis with ocular involvement

Today I saw a 45 years old patient who came to me for routine eye examination when I found black bluish spots at his palms. I found bilateral episcleral/scleral pigmentation on temporal sides of both eyes. On reviewing the literature in which nasal espisclera is involved most of the times and ocular involvement in the form of scleral/episcleral pigmentation occures between the age of 30-39.
I could not find another sign of this disease in this patient.
Ochronosis is an association of alkaptonuria.
These are the photographs of the patient I took, who is a resident of Pakistan and he gives a positive history of this autosomal recessive rare disorder.
The prevalence is of 1 case per 1 million population in american population.
And 1 case per 25000 inhabitants worldwide with peak prevalence at Czech Republic and Santo Domingo.
we don't have any records for pakistan

Dr. Shahzad waseem