This document discusses various types of corneal degenerations and dystrophies. It provides descriptions of conditions such as arcus senilis, band keratopathy, corneal dystrophies, and corneal depositions. The causes, characteristics, associated systemic diseases, histopathological features, and treatments are summarized for each condition.

1. Dr. K. Vasantha M.S., F.R.C.S.
Director RIO Chennai (Rtd)

2.  Bilateral, symmetrical
 Mostly central cornea
 Non-inflammatory,
hereditary disorders,
little or no
relationship to
systemic or
environmental
factors
 Not accompanied by
vascularisation
 Mostly AD
 Unilateral,asymmetric
 Mostly peripheral
cornea
 D/t aging,trauma,
inflammation or
systemic diseases
 Accompanied by
vascularisation
 Deterioration or
change in a normal
tissue that renders
the tissue less
functional
Corneal degenerations

3.  Bilateral-type 2
hyper-
lipoproteinemia
 Gray/white/yello
w band
separated from
limbus by a
clear zone of
0.2-0.3 mm
clear zone called
lucid interval of
Vogt. This may
get thinned-
senile furrow
Diffuse central &
sharp peripheral
border

4.  In arcus senilis there is deposition of
cholesterol, cholesterol esters, neutral fats
and phospholipids in the extra cellular spaces
of the peripheral stroma.
 First appears in the inferior stroma and the
posterior layers and then spreads

5.  Hyperlipoproteinemia Type 2 &3
 Increased β lipo proteins – Nephrotic
syndromes, hypothyroidism, high cholesterol
intake, obstructive jaundice, diabetic keto
acidosis
 If it is unilateral think of carotid artery
disease
 Also in lecithin cholesterol acyltransferase
def. and Tangier disease2

6.  Hudson-Stahli line : occurs in the inferior
third of the cornea in old age without any
pathology
 Fleischer’s ring : epithelial iron deposit at the
base of the keratoconus
 Ferry’s line: corneal margin of the filtering
bleb
 Stocker’s line : proximal to the advancing
edge of the pterygium

7.  Argyrosis: if silver containing drops are used
gets deposited in the DM
 Chalcosis: deposition of copper
 Chrysiasis: deposition of gold in patients with
arthritis using gold compounds
 Topical epinephrine can cause deposition of
adrenochrome, which are brown or black in
color

8.  Iron deposition at level of
bowman’s layer
 Associated with previous corneal
foreign body

9.  White crescent like
line along nasal &
temporal limbus
 Type1-seperated
from limbus by a
clear zone
 Type 2-no clear zone
between it & limbus
 HPE: subepithelial
lesion with
hyperelastosis & mild
hyaline degeneration

10.  Area within interpalpebral fissure is affected.
Centre of band will be slightly inferior to the
centre of cornea
 Swiss-cheese like appearance: clear circular
areas within the band is seen where nerve
endings perforate Bowman’s layer

12.  Non crystalline deposition of ca phosphate,
hydroxyapatite, and calcium carbonate in
Bowman’s membrane & superficial stroma
 starts in periphery leaving a clear zone
between limbus & opacity.
 Involves interpalpebral area just below the
centre
 Von Kossa stain is used to detect calcium
deposit

13. ASSOCIATED WITH
 Chronic Uveitis
 Pthysis bulbi
 Absolute glaucoma
 Juvenile rheumatoid arthritis
 Interstitial keratitis
 Trauma

14.  Sarcoidosis, Fanconi’s syndrome,
hypophosphataemia, multiple myeloma,
lupus, vit.D toxicity, lung and bone disease
with increased calcium, ichthyosis
 In gout deposition of urate crystals can be
seen
 In primary band keratopathy (hypercalcaemia)
the deposits will be intracellular
 In secondary it will be extracellular
 Treatment: chelation with EDTA (0.4%), PTK

16.  Sometimes in long
standing opacities
calcium deposits will
occur. If the deposit
falls off it disrupts
the epithelium
forming an ulcer
called atheromatous
ulcer

17.  Unlike band keratopathy it involves deeper
layers of cornea also.
 Seen in grossly distorted globes and
leucomas
 Maybe associated with intraocular bone
formation

18.  In corneas that had been
inflamed many years
earlier
 E.g.: phlyctenular
keratitis, trachoma,
vernal keratitis etc.,
 Elevated blue-grey,
fibrous nodules in
superficial stroma, just
beneath epithelium
 Base of nodule maybe
surrounded by iron
deposition
 HPE: mound of dense
collagenous tissue

19. Common characteristics of both Pellucid and
Terrien’s are
 Non inflammatory
 Slowly progressive
 Epithelium and endothelium are normal
 Stromal thinning
 Bowman’s will be disrupted
 Defective vision due to against the rule
astigmatism

21.  Bilateral, narrow band of thinning in periphery
with normal tissue between limbus &
degenerated cornea in the inferior quadrant
 Typical kissing birds sign with topography
 High astigmatism, keratoconus or keratoglobus
can be seen in other members of the family
 Treatment – C shaped lamellar or full thickness
graft
 Hybrid or scleral lenses
 Very rarely hydrops can occur

22.  Unilateral or asymmetrically bilateral
 Fine, punctate stromal opacity with a lucid
zone is seen in the superior cornea
 Lucid zone becomes superficially
vascularised and can form a pseudo
pterygium
 The thinning is parallel to limbus
 Lipid deposits are seen in the lower margin
which is steep but no over hanging edge as
in Mooren’s

23.  Corneal elastosis, Labrador
keratopathy, climatic droplet
keratopathy, Bietti nodular
dystrophy etc.,
 Predisposing factor: UV-
exposure
 Clusters of fine, yellow, gray,
amber or gold colored droplets
are seen beneath epithelium of
cornea
 Begins peripherally & advances
towards the centre
 Dark red
proteinaceous
deposits are seen in
the anterior stroma
replacing BM

24.  Type 1. bilateral without other ocular
pathologies
 Type 2. Secondary to other ocular pathology
 Type 3. with conjunctival deposits either with
type one or two

25.  The deposits contain tryptophan, tyrosine
and other sulphur containing amino acids.
 Immunoflorescence techniques show
presence of IgA and IgG

26.  If the lesion is superficial without
involvement of the Bowman’s, simple
scraping or PTK can be done
 If it is deeper lamellar keratoplasty is done
 Ocular surface disorders like dry eye must be
looked for as it is prevalent in these patients

27.  Can occur primarily
in normal cornea
 Secondary to other
chronic
inflammations
 Treat the
vascularisation first
 Keratoplasty

28.  Discrete, tiny, gray/white opacities, scattered
throughout deep corneal stroma-FLOUR
DUST APPEARANCE
 HPE: lipofuscin like material-due to ageing,
wear & tear

29.  Punctate and filamentous opacities;
appear transparent and glassy on
retro illumination
 Lesions are axial and posteriorly
located

30.  SENILE FURROW DEGN: in the lucid interval
between an arcus & limbus
 CORNEA GUTTATA: common, bilateral, tiny
dark spots on central endothelium
rarely progress to Fuchs’ dystrophy
 HASSAL-HENLE BODIES/WARTS: localized areas
of nodular thickening in peripheral cornea

31.  Filamentary keratitis
 K.F. ring

33.  Seen in severe dry eye – to be treated with
cyclosporine and artificial tear drops
 Superior limbic kerato conjunctivitis
 Mucus strands attached to the cornea are
surrounded by epithelium. These have to be
sometimes removed and anterior stromal
puncture done to prevent recurrence

34.  Deposition of copper in the Descemet’s
membrane
 Starts in the periphery. So if a patient is
referred to rule out K.F. ring one must see
with a gonioscope also
 Seen in chronic liver damage due to Wilson’s
disease

35.  In Wilson’s disease it is usually starts at the
age of around ten.
 It is also seen in primary biliary cirrhosis and
familial cholestatic disease
 Diffuse deposits are seen in pulmonary
carcinoma and multiple myeloma

37.  Bilateral
 Present at birth, with uniform thinning
 Familial association with keratoconus has
been noticed
 Seen in Ehlers- Danlos also
 Spectacle correction will yield reasonable
vision
 Large diameter lamellar or penetrating
keratoplasty can be tried