50-year-old Caucasian man from Wyoming presents with blurry vision in the left eye
Patient reports fuzzy and monocular double vision in the left eye for prior two to three months
Patient states he feels growth on the cornea OS
No previous ophthalmologic problems within his immediate family
Past medical history: hypertension, hyperlipidemia, under good control
Social history: professional photographer, non-smoker
Previous surgical history of superficial keratectomy in both eyes
Exam Findings
VA 20/20 || 20/60 PH 20/40
Pupils RR OU, no RAPD
IOP (Tp) 12, 13
EOMI
Figure 1: External photograph of patient’s right eye depicting large, paracentral corneal opacification.Figure 2: Slit lamp photograph of patient’s right eye. Note that the layer of involvement of the corneal opacity is within the epithelium.Figure 3: Sclerotic scatter demonstrating white-gray paracentral opacification with feathery borders and densely crowded microcysts without clear, intervening zones.Figure 4: Slit lamp photograph of patient’s left eye. Corneal opacity within the epithelium.Figure 5: Sclerotic scatter demonstrating white-gray paracentral opacification with feathery borders and densely crowded microcysts without clear, intervening zones.Figure 6: Anterior segment OCT with sharp demarcation of the epithelium, from hyperreflective to normal cornea.Figure 7: A and B show no astigmatism OU.
Differential Diagnosis
Lisch corneal dystrophy
Meesmann corneal dystrophy
Epithelial basement membrane dystrophy
Thiel-Behnke corneal dystrophy
Reis-Bücklers corneal dystrophy
Systemic: verticillata
Limbal stem cell deficiency
Ocular surface squamous neoplasia
Diagnosis
Lisch corneal dystrophy
Pathophysiology
Corneal dystrophies
Bilateral, symmetric inherited conditions
Slowly progressive and more pronounced over age
Genetics: TGFB1, protein keratoepithelin
corneadystrophy.org for classifications
Lisch corneal dystrophy
X-linked dominant; unknown gene
Slit lamp: discrete sectoral, gray, band-shaped and feathery lesions that appear in whorled pattern
Retroillumination: intraepithelial, densely crowded microcysts with surrounding clear cornea
No pain (recurrent erosions)
Differentiates from other anterior corneal dystrophies
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