Keratopathy: white patches, clear dots and grey lines
- Division of Ophthalmology and Visual Sciences, University of Nottingham, Nottingham, UK
- Correspondence to Professor Harminder S Dua, Division of Ophthalmology and Visual Sciences, B Floor, Eye Ear Nose Throat Centre, University Hospital, Queen's Medical Centre, Nottingham NG7 2UH, UK; harminder.dua{at}nottingham.ac.uk
A 62-year-old lady presented to the clinic in September 2009 complaining of a 1-month history of decreased vision in the left eye with no associated pain or redness. On examination, the logMAR best-corrected visual acuity (BCVA) was −0.1 in the right eye (RE) and +0.5 in the left eye (LE). Slit-lamp examination of the LE revealed a subepithelial whitish flat lesion, 4 mm by 1.5 mm. This was surrounded by multiple well-defined translucent spots (figure 1). The corneal periphery showed a faint grey ring. The intraocular pressure was 16 mm Hg. Fundus examination was normal. The RE examination was unremarkable except for a faint grey ring at the corneal periphery.
(A) Slit-lamp photomicrograph showing the white subepithelial patch. (B) A part of the image has been enhanced to highlight the translucent dots and the grey semicircular line at the periphery of the cornea.
Questions
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What other relevant history would one elicit in this case?
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What is the likely clinical diagnosis? What do the whitish flat lesion and the translucent spots seen in figure 1 represent?
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What are the management options?
See page 149 for answers
Answers
From questions on page 133
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What other relevant history would one elicit in this case? History of previous corneal surgery, trauma or use of eye-drops is important. Her previous ocular history revealed two episodes of bilateral laser in situ keratomileusis (LASIK). The preoperative refraction was +3.0/−2.50×167 for the RE and +2.5/−1.25×17.5 for …
