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Dystrophy's
- Bilateral
- Congenital
- Rare
- Slowly progressive and stabilize by age 20-30
- No infiltrates,
- No thinning
- No neovascularization
- Usually central location,
- Usually involves only one corneal layer
Epithelium
Map-dot-fingerprint
- Epithelial basement disorders (EBMD)
- Basal epithelial cells secretes basement membrane which attaches
the epithelium to the stroma
- Takes 6-8 weeks to reform
- Migration of cysts to surface leads to RCE (AM syndrome)
- Projections from the basal cells trap cells and debris forming
microcysts (Seen as dots)
- Intraepithelial changes lead to negative stain and reduced acuity
- Maps, dots, fingerprints
- Hold lids open and tell pt to shut eyes
- Positive EBMD and negative bells phenomena predicts 75% chance
of spontaneous erosion
- 50% of recurrent erosions have EBMD
- Preventative therapy
- Sicca worse in PM EBMD worse in AM
- Autosomal dominate?
- Small number are congenital dystrophy most age related
- Cyst like vesicle's in epithelium
- Ridges
Bowmans membrane
Anterior moasic dystrophy
- Crocodile shagreen
- Central gray polygonal opacities with a clear zone around
- Blanches with limbal pressure
- No problem
Ring dystrophy
- Reis-Bucklers
- “Fish net” swirls stromal haze
- Painful reccurent erosion
- Less problem after age 30
Anterior stroma
Central crystalline dystrophy (Schnyder's)
- Central crystals during first 2 decades
- Dense arcus during next 2 decades
- Associated with high cholesterol (Refer for blood panel)
Granular dystrophy (Groenouw’s)
- First decade
- Discrete white translucent hard cornflake or powdery dots
- Need keratoplasty
Anterior stromal line dystrophy (Lattice) (Biber's)
- Re-occurent erosions
- Autosomal dominant
- X-crossed lines
- Late teen or post surgical
Full stroma
Fleck dystrophy (Francois-Neetens)
- Gray or white ring by age 2
- Extends to periphery
- No problem
Macular dystrophy (Groenouw's)
- Diffuse ground glass haze with white or grey opacities
- Extends to periphery
- Autosomal recessive
- Late corneal guttata and erosions
- Rare but devastating
Deep stroma
Central cloudy dystrophy (Francois's)
- Fuzzy grey areas deep in stroma
- No problem
Posterior amorphous dystrophy
- Gray sheet in first decade to periphery
- No problem but may reduce acuity to 20/40
Pre-Decemet’s dystrophy (Farinata)
- Deep punctate or filimentary opacities
- No problem
Endothelial
Congenital hereditary endothelial dystrophy
- Recessive form congenital with nystagmus
- Dominate form no nystagmus
- Diffuse ground glass edema
- 2-3 times corneal swelling
- Erosions
- May extend to periphery
- “Orange peel” effect in decemets
Late endothiel dystrophy (Fuch’s)
- Progressively more guttata of endothelium
- Stromal edema (Wet “ground glass” bedewing)
- Much more common in post-menopausal females
- Appears to affect several layers
- Thickening of decemets
- Stromal edema
- Endothelium cells enlarge, lose hexagonal shape and thin
- AM erosions
- 10 min. hairdryer
- Soft lenses for bullous keratopathy
- Low minus RX for AM
Posterior polymorphous dystrophy (Schlicting's)
- Grouped vesicle's forming “Swiss cheese” pattern
- Gray lines in decemets forming “Railroad tracks”
- Watch IOP
- May reduce acuity slightly
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