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Lineses, Pamela Louise M. Ocular Disease I

ODP-2A

CORNEAL DYSTROPHIES 

CORNEAL

DYSTROPHIES   SIGN SYMPTOM  COMMON 

MANAGEMENT/ 

TREATMENT  

1. Epithelial 

Dystrophies  

1.1. Juvenile

EpithelialDystrophy (of Meeshman)

1.2. RecurrentCornealErosion

1.3. EpithelialBasementMembraneDystrophy

● clear dot or cyst in

the cornealepithelium thatoccasionallyruptures)

● photophobia● lacrimation

● Recurrent cornealErosion

● often follows anuncomplicatedcorneal abrasion

●

Examinationindicates a cornealare denuded of epithelium

● minute opacities

● corneal epithelialcell form an ever-changing subtlepattern of minor opacites describe

as map-dot-fingeprint, bleblikeor microcystic

● mild irritation●

slight decrease inclarity of vision(visual acuity)

● Severe , sharpocular pain uponawakening

● most patients areassymptomaticubless recurrentcorneal erosionoccurs

●

 

● ●

Treatment is solelysymptomatic

● patching● instillation of 

petrolatum oinment(prevention of 

eyelid tio adhere tocorneal epithelium)●minute puncture of 

the basementmembrane withfine curve needle or Nd: Yag Laser 

● nighttime lubricatingointments or hypertonic salineointments

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2. Bowm an Layer 

Dystrophies 

2.1.Reis-Bucher Central corneal

dystrophy

2.2. Thiel-BehnkeDystrophy(Honey Comb)

● ring shaped,superficial opacity in

the central cornea● corneal erosion that

gradually cease atthe center of thecore

● Typical honeycombopacity in thecornealsubepithelium regiondevelops in thesecond decade of life

● pain● photophobia●

foreign bodysensation● reduce visual acuity● irregular 

astigmatismcombined withcornealopacification

● recurrent painfulerosions

● decreased vision

● Superficialkeratectomy may

help with thesuperficial cornealscarring

● lamellar Keratoplasty

● excimer laser keratectomy

● In more severecases, a partial or complete cornealtransplantation maybe considered

● 

3. Strom al 

Dysthrophies 

3.1. Central MaculaDystrophy(Groenouwtype II)

3.2. lattice cornealDystrophy

● begins in childhoodas a diffuse cloudingand progres untilentire thickness of cornea contains grayspot

● recurrent erosionmay occur 

● characterized by thedevelopment of lesions that formbranching lines thatresemble cracked

● pain due torecurrent erosion

● pain

● penetratingkeratoplasty

● keratoplasty● corneal transplant● excimer laser 

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3.3. Granular CornealDystrophyType I

3.4. Granular CornealDystrophyType II

3.5. Schnyder CrystallineCornealDystrophy

glass or thecrisscrossed,overlapping patternof lattice

● corneal opacities

● small particles(granules) thatcollectively resemblebreadcrumbs(develops in secondor third decade of life)

● lesion combines toform larger lesion

● recurrent cornealerosion can occur 

● develop on thestroma usuallybeginning in the firstor second decade of life

● opacities in thecornea

● superficial, fineopacities thatresemble rings,discs, stars or snowflakes mostdense centrally 

● opaque corneas dueto an accumulationof fat or cholesterol

● Central, oval ,subepithelialcrystalline opacity

●Diffuse cornealhaze, prominentcorneal arcus

● 

● pain

● 

● clouding, hazinessand blurred vision

● Visual impairment,glare

● penetratingkeratoplasty

● Treatment- usuallynot required

● Excimer laser keratectomy.

● corneal transplantmay be indicate

● 

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4. Endothelial 

Dystrophies 

4.1. FuchsEndothelial

Dystrophy

4.2. Posterior PolymorphousDystrophy

4.3. CongenitalHereditaryEndothelialDystrophy

● develops duringmiddle age, bilateral

condition●warthlike excresence● Tiny blisters form on

the cornea● endematous cornea

● characterizeddescemetmembrane withlocalized excerences

● endothelial cellsresembles fibroblastor epithelial cells

● opacity

● bilateral symmetricaldiffuse cornealedema

● blue gray groundglass appearance tototal opacification

● pain● reduce vision

● often asymptomatic

● pain

● hypertonic saline or glucose solution

dehydrate theedematous corneaand may improvevision

● Corneal transplant if impairment of visionoccurs

● not required

● sodium chloridedrops, in attempt toreduce the cornealswelling 

● cornealtransplantation,may be considered.