Atypical Presentation of Salzmann Nodule: A Case Report and Literature Review

Abstract

Salzmann's nodular degeneration (SND) is an unusual corneal condition that is slowly progressive and noninflammatory in nature. It results in millimetric gray-white to bluish nodules formation anterior to Bowman's layer of the cornea. It usually affects both eyes in 80% of the cases. These elevated nodules are located near the limbus or in the mid-peripheral cornea, with some exceptions. Salzmann nodule develops following corneal trauma or inflammation. However, it can present idiopathically.Here, we report an atypical case of idiopathic symptomatic large central SND that was treated successfully with superficial keratectomy.

Atypical Presentation of Salzmann Nodular Corneal Degeneration as a Subepithelial Corneal Dystrophy: A Case Report

“…Histologically, the findings of SNCD include the presence of epithelium and fibroblastic degeneration, absent or disrupted Bowman’s layer, hyaline plaques between corneal epithelium and Bowman’s layer, deposition of extracellular matrix, and irregular stroma collagen fibrils. The hyaline material does not stain for elastin, amyloid, or reticulin [ 4 , 10 , 14 , 15 ]. These findings were demonstrated in our case, which confirmed the diagnosis of SNCD even though it was initially thought to be subepithelial dystrophy based on clinical findings.…”

“…Surgical options include superficial keratectomy, lamellar keratoplasty, and penetrating keratoplasty. Additional adjuvant interventions such as mitomycin-C and amniotic membrane might be beneficial in SNCD [ 4 , 6 , 11 ]. Carroll et al reported that 90% of cases showed visual improvement post-surgical intervention [ 17 ].…”

“…It is a rare, non-inflammatory slowly progressive degenerative disease of the cornea, which presents as bluish-gray opacity varying in number and sizes [ 1 , 3 ]. It commonly involves the midperipheral to peripheral cornea anterior to Bowman’s layer [ 4 , 5 ]. Although the disease is usually idiopathic, it can be associated with an inflammation, trauma, and surgery.…”