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Keratopathy: white patches, clear dots and grey lines
  1. Usama Fares,
  2. Fizza Mushtaq,
  3. Dalia Said,
  4. Harminder S Dua
  1. Division of Ophthalmology and Visual Sciences, University of Nottingham, Nottingham, UK
  1. 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

https://doi.org/10.1136/bjo.2010.184416

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    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.

    Figure 1

    (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

    1. What other relevant history would one elicit in this case?

    2. What is the likely clinical diagnosis? What do the whitish flat lesion and the translucent spots seen in figure 1 represent?

    3. What are the management options?

    See page 149 for answers

    Answers

    From questions on page 133

    1. 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 …

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    Footnotes

    • Competing interests None.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.