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SYMPTOMS
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Blur | Distorted vision | Image ghosting
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SIGNS
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Peripheral corneal thinning and protrusion (usually inferior) | Irregular astigmatism | Topography shows peripheral corneal elevation - 1-2 mm from the limbus
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WORK-UP
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Thorough history. Slit lamp examination. Topography
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TREATMENT
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Mild PMD may be managed visually with glasses and/or soft contact lenses | Moderate-Severe PMD may be better managed with rigid gas permeable or scleral lenses | Progressive PMD should be monitored closely with topography/tomography | Advanced cases may undergo corneal transplantation
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DIFFERENTIAL DX
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Keratoconus | Keratoglobus | Post-LASIK ectasia | Terrien marginal degeneration
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NOTES
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There is no inflammation associated with PMD | Corneal hydrops is an uncommon occurrence | Corneal transplants for PMD usually require a larger graft than KCN procedures, with a higher risk of graft failure
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