Cornea/Refractive Surgery Quiz 4

Scott Burk, MD/PhD | Massachusetts Eye and Ear Infirmary, Harvard Medical School

September 17, 1996
Figure 1
Figures 1-3. These are three photographs showing variations of the same corneal condition
Figure 2
Figure 3
Questions and Answers
1. What is your diagnosis?
Answer: Epithelial basement membrane dystrophy with characteristic geographic opacities (maps) intra-epithelial microcysts (dots) and subepithelial ridges (fingerprints)

2. What is the usual age range for this condition?
Answer: Symptoms become prominent in early adulthood and throughout middle age.

3. What are the symptoms?
Answer: Symptoms range FROM minor early morning irritation to significant corneal epithelial erosion.

4. What is the pathophysiology of this condition?
Answer: The epithelium produces an abnormal multilaminar basement membrane to which there is poor adherence. Frequently there is elevation and reduplication of this basement membrane within the epithelium. The intra-epithelial basement membrane layer blocks normal migration of epithelium below leading to inclusion cysts. The end result is a poorly adherent epithelium further destabilized by intra-epithelial inclusions.

5. What treatment would you recommend?
Answer: Conservative treatment focuses on factors which control recurrent erosive episodes including copious lubrication, patching, or bandage contact lenses. Careful debridment of grossly abnormal epithelium and rarely superficial keratectomy are used to remove subepithelial debris.