degeneraciones corneales

1. CORNEAL DEGENERATIONS
1. Age-related
• Arcus senilis
• Vogt white limbal girdle
2. Lipid keratopathy
• Crocodile shagreen
• Cornea guttata
• Primary
• Secondary
3. Band keratopathy
4. Spheroidal degeneration
5. Salzmann nodular degeneration

2. Arcus senilis
• Innocuous and extremely common in elderly
• Occasionally associated with hyperlipoproteinaemia
• Bilateral, circumferential bands
of lipid deposits
• Diffuse central and sharp
peripheral border
• Peripheral border separated
from limbus by clear zone
• Clear zone may be thinned
( senile furrow)

3. Vogt white limbal girdle
• Innocuous and very common in elderly
• Bilateral
• White, crescentic line along nasal and temporal
limbus
• Type 1 - separated from limbus by clear zone
• Type 2 - not separated by clear zone

4. Crocodile shagreen
• Uncommon and innocuous
• Usually bilateral
• Polygonal stromal opacities separated by
clear space
• Most frequently involve anterior stroma
(anterior crocodile shagreen)
• Occasionally involve posterior stroma
(posterior crocodile shagreen)

5. Cornea guttata
• Common, bilateral and usually innocuous
• Rarely progression to Fuchs dystrophy
• Tiny dark spots on central endothelium
• Similar peripheral lesions are Hassell-Henle bodies

6. Lipid keratopathy
• Usually unilateral stromal deposits
without vascularization
• Rare, occurs spontaneously in
avascular cornea
• Unilateral stromal deposits with
vascularization
• Common, secondary to previous
disciform keratitis
Treatment - coagulation of feeder
vessels and/or keratoplasty
Treatment - keratoplasty, if severe
Primary Secondary

7. Band keratopathy
• Interpalpebral limbal opacification
• Common, unilateral or bilateral depending on cause
• Subepithelial calcification
• Central spread of calcification
• Small holes within calcified area
• Separated by clear zone
Progression

8. Causes of Band Keratopathy
1. Ocular (common)
• Silicone oil in anterior chamber
• Increased serum calcium and phosphorus
• Chronic iridocyclitis, particularly in children
• Hyperuricaemia
• Associated with phthisis bulbi
3. Hereditary (rare)
• Chronic renal failure
• Familial band keratopathy
• Hereditary ichthyosis
2. Metabolic (rare)
4. Age-related (uncommon)

9. Removal of corneal epithelium Application of sodium versenate
Chelation of band keratopathy

10. Spheroidal degeneration
Treatment
Central spread, coalescence and
opacification
Advanced lesions become
nodular and elevated
• Rare, typically affects outdoor workers
• Starts with peripheral, interpalpebral, small amber-coloured
granules in superficial stroma
• Debridement or superficial keratotomy if mild
• Keratoplasty if severe
Progression

11. Salzmann nodular degeneration
• Uncommon, unilateral or bilateral
• Secondary to chronic keratitis
• Discrete superficial stromal opacities
and nodules
• Base of nodule may be surrounded by
iron deposits
Treatment - similar to spheroid degeneration