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Masquerade ectasia
  1. Virinder K Dhillon,
  2. Mohamed S Elalfy,
  3. Réka Albert,
  4. Parth A Shah,
  5. Khalid Mahmood,
  6. Harminder S Dua
  1. Academic Ophthalmology, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK.
  1. Correspondence to Professor Harminder S Dua, Division of Clinical Neuroscience, B Floor, Eye ENT Centre, Queens Medical Centre, University of Nottingham, Derby Road, Nottingham NG7 2UH, UK; harminder.dua{at}

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A 41-year-old otherwise healthy Pakistani male presented to our Cornea Clinic. He gave a history of bilateral, gradual, childhood onset myopia for which he used soft contact lenses (CL) daily for 20 years until 2009. Then, due to increasing astigmatism, he switched to rigid gas permeable (RGP) CLs. Because he experienced increasing discomfort after a year of using RGPs, his CL specialist tried several other CL options over the following 2 years, including mini-scleral and ‘piggy back’ lenses with little success.

On examination, his right eye Log MAR corrected visual acuity with glasses was 0.58, best corrected to 0.28 oculus dexter (OD) and 0.22, best corrected to 0.02 oculus sinister (OS). His slit-lamp photomicrographs and topographical findings are shown below (figure 1). Keratometry readings revealed irregular astigmatism of +9.40D OD and +11.90D OS.

Figure 1

(A and B) Enhanced high magnification slit-lamp photomicrographs of the right and left eyes, respectively, showing the bilateral ‘beer-belly’ protrusion and apical thinning of the inferior corneas. (C) Corneal topographical image of the right eye showing the broadly displaced inferior steepening. (D) Corneal topographical image of the left eye showing irregular against-the-rule astigmatism and the ‘kissing doves’ sign. OD, oculus dexter; OS, oculus sinister.


  1. Describe the findings in figure 1 and the most likely diagnosis …

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  • Contributors VKD, MSE, RA and PAS shared in editing the manuscript and figures preparation, and literature search. KM and HSD shared the diagnosis plan. KM obtained the topography images. HSD took the photos and gave the insight of the management plan and the idea behind the article. He also supervised and revised the work.

  • Competing interests None.

  • Patient consent Obtained.

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