Multiple punctate subepithelial corneal lesions

Abstract

A 61-year-old woman was referred to the Centro Oftalmológico Virgilio Galvis (Floridablanca, Colombia), because of dry eye symptoms. She has always lived in Colombia. The patient had a diagnosis of primary open-angle glaucoma in both eyes, treated with latanoprost 0.005%. Her medical, surgical and family histories were unremarkable. Her best-corrected visual acuity was 0.1 LogMAR (Snellen 20/25) with refraction −2.00 −2.00×110°i n the right eye and 0.1 LogMAR (Snellen 20/25) with refraction −1.75 −2.00×80°in the left eye. Goldman tonometry was 16 mm Hg for both eyes. During a slit lamp examination we observed multiple punctate subepithelial corneal lesions in the left eye ( figure 1A,B). They were six in total. Two lesions were located superior and inferior in the peripupillary area, one in the nasal midperiphery and three in the periphery (nasal, superior and inferior) of the cornea. The lesions had a white centre surrounded by a halo, less intense in colour, and around three to four times larger than the central dot. The sizes of the central whiter dots were between approximately 0.1 and 0.2 mm and the diameters of the surrounding paler halo areas varied between approximately 0.4 and 0.6 mm. the lesions did not stain with fluorescein (figure 1C). Our patient had no symptoms related to those lesions. Fundus examination showed a cup-disc ratio of 0.5 with normal macula and peripheral retina in both eyes.Anterior segment optical coherence tomography (Visante-OCT; Carl Zeiss Meditec, Dublin, California, USA) crossing one of the lesions showed a hyper-reflective area located under the corneal epithelium (figure 2). Figure 1 (A) Six small corneal subepithelial lesions (arrows) in the left eye of the patient. (B) Higher magnification view of five of the lesions. (C) Lesions did not stain with fluorescein. This figure is only reproduced in colour in the online version.Figure 2 Anterior segment optical coherence tomography (Visante-OCT; Carl Zeiss Meditec, Dublin, California, USA) crossing the inferior peripupillary lesion. A hyper-reflective area located under the corneal epithelium can be seen (white arrow). This figure is only reproduced in colour in the online version.

Prevalence of Punctate Keratopathy of West Indians in a Colombian Referral Center and a New Name Proposed: Rice´s Keratopathy

“…Some patients were followed for up to 18 months and the opacities remained unchanged [ 1 ]. As we already indicate it seems to be rather frequent in the Antilles [ 1 , 2 ], but other publications confirmed that the condition was not restricted to people of African-Caribbean descent, but also presented in Caucasians and Hindus who had lived in the Antilles [ 2 , 4 , 5 ], and in other human groups of Central and South America [ 3 , 6 , 7 ]. Curiously it seems to be inexistent in Caucasians, Africans or Asians who have not lived in the Antilles or Central/South America.…”

“…Standard slit-lamp examination was performed by the ophthalmology residents and ophthalmologists, all of them carefully looking for the clinical features of the condition in all the patients: corneal white dot-like lesions surrounded by a paler halo, 0.5 mm. or less in diameter, lying at the level of Bowman's membrane and usually extending into the superficial anterior stroma [ 1 - 7 ]. When present, the number and location of the lesions were registered in the electronic medical record.…”

“…In our practice in Colombia with some frequency we had found the condition, and recently reported three cases [ 6 , 7 ]. We decided to determine the prevalence in our patients.…”