Cornea

Crocodile Shagreen SYMPTOMS No symptoms SIGNS White-gray polygonal opacities (resembling “crocodile scales”), usually peripheral WORK-UP Thorough history. Slit lamp examination TREATMENT Observation, no treatment is indicated FOLLOW-UP Frequent follow-ups are not necessary ADDITIONAL LAB | TESTS None ETIOLOGY Senescence DIFFERENTIAL DX Central cloudy dystrophy of Francois NOTES None Orbit Eyelid | Eyelashes Lacrimal Conjunctiva Episclera…

Posterior Embryotoxon SYMPTOMS No symptoms SIGNS Concentric, white opacification anterior to the limbus – usually temporal and/or nasal WORK-UP Thorough history and slit lamp examination. Gonioscopy may be considered TREATMENT Observation, no treatment is indicated FOLLOW-UP Frequent follow-ups are rarely necessary. ADDITIONAL LAB | TESTS None ETIOLOGY Inheritance – autosomal dominant DIFFERENTIAL DX White limbal…

White Limbal Girdle of Vogt SYMPTOMS No symptoms SIGNS White-yellow peripheral opacification – usually temporal and/or nasal WORK-UP Thorough history. Slit lamp examination TREATMENT Observation, no treatment is indicated FOLLOW-UP Frequent follow-ups are not necessary ADDITIONAL LAB | TESTS None ETIOLOGY Senescence DIFFERENTIAL DX Arcus senilis | Kayser-Fleischer ring | Terrien marginal degeneration NOTES White…

Arcus Senilis SYMPTOMS No symptoms SIGNS White-gray peripheral lipid deposition with limbal clearing WORK-UP Thorough history. Slit lamp examination TREATMENT Observation, no treatment is indicated FOLLOW-UP Frequent follow-ups are not necessary ADDITIONAL LAB | TESTS None ETIOLOGY Unknown, although there is association with hyperlipidemia DIFFERENTIAL DX Arcus juvenilis | Kayser-Fleischer ring | Terrien marginal degeneration…

Dellen SYMPTOMS Foreign body sensation | Often asymptomatic SIGNS An area of corneal thinning/excavation adjacent to corneal elevation – usually around the limbus | Injection WORK-UP Thorough history. Slit lamp examination with NaFl dye TREATMENT Preservative-free artificial tears q2-4h | Lubricating ointment at night | Surgical removal/repair of the lesion may be indicated FOLLOW-UP Every…

Ultraviolet Keratitis (Photokeratitis) SYMPTOMS Pain | Photophobia | Blurry vision | Tearing SIGNS Dense, diffuse punctate corneal epithelial defects | Injection | Tearing WORK-UP Thorough history. Slit lamp examination with NaFl dye TREATMENT Copious use of preservative-free artificial tears | Bandage contact lens | Cycloplegic drop (cyclopentolate 1% 1 gtt bid) | Oral acetaminophen and/or…

Corneal Verticillata SYMPTOMS Mostly asymptomatic | Rarely is vision affected SIGNS Whorl-like corneal epithelial opacities | Usually gray or golden brown WORK-UP Thorough history. Slit lamp examination TREATMENT Observation | Discontinuation of the causing medication is typically not required FOLLOW-UP Annually ADDITIONAL LAB | TESTS None ETIOLOGY There are several causes of corneal verticillata, including:…

Band Keratopathy SYMPTOMS Discomfort | Reduced vision | Sometimes asymptomatic SIGNS Gray-white calcium deposition at Bowman membrane, usually horizontal across the cornea WORK-UP Thorough history. Slit lamp examination TREATMENT Preservative-free artificial tears | Bandage contact lenses | EDTA chelation of the calcium plaque FOLLOW-UP Every 3-12 months depending on severity ADDITIONAL LAB | TESTS None…

Bullous Keratopathy SYMPTOMS Pain | Blurry vision | Photophobia | Tearing SIGNS Injection | Corneal bullae | Edema | Corneal folds | Tearing | Corneal scarring/haze WORK-UP Thorough history and slit lamp examination with NaFl stain | Pachymetry and specular microscopy may be considered TREATMENT Muro 128 (sodium chloride 5%) drops and/or ointment | Bandage…

Epithelial Basement Membrane Dystrophy (EBMD) SYMPTOMS Blurry vision | Discomfort from corneal erosions SIGNS Gray-white epithelial opacities (dots, cysts, lines) | Corneal erosions (usually in the morning) WORK-UP Thorough history. Slit lamp examination TREATMENT Observation | Nighttime lubricating gel/ointment | Bandage contact lenses | Anterior stromal puncture | Phototherapeutic keratectomy FOLLOW-UP Frequent follow-ups are rarely…