Salzmann's nodular degeneration of the cornea

Abstract

Salzmann's nodular degeneration is a rare condition characterised by elevated bluish‐white to grey sub‐epithelial nodules in the cornea. This paper presents two case reports of this corneal disorder and discusses appropriate management strategies.

Corneal Nodules and Possible Pathologies: A Case Series

“…The mechanism of corneal lesion formation in Salzmann nodular degeneration remains unknown. However, it is believed that the disruption of barrier occurs between the epithelial basement membrane and stroma due to several conditions such as ocular trauma, chronic corneal irritation from meibomian gland disease, ocular surface disease, and non-inflammatory conditions, which include postoperative corneal surgery, corneal epithelial basement membrane dystrophy, and hard contact lenses [ 8 ]. Fibroblasts and myofibroblasts are activated and migrated anteriorly through disrupted epithelium basement membrane followed by deposition of disorganized extracellular matrix components which lead to nodule formation [ 9 ].…”

“…Histologically, pterygium is thought to originate from altered limbal stem cells which extend centripetally to involve the cornea. On the other hand, Salzmann nodular degeneration does not involve limbal stem cells due to hyaline degeneration of collagen with excessive secretion of basement membrane-like material [ 8 , 9 , 11 ]. In our patient, pterygium could have been a chronic irritant to the ocular surface, which is a predisposing factor to the development of corneal nodules.…”

“…Preceding ocular injury, surgery, and ocular surface disease should be identified as they may provide clues to the underlying pathology. Salzmann nodular degeneration occurs because of previous orbital disease [ 8 ], corneal surgery, and ocular trauma while the ocular infection is a risk factor for corneal pyogenic granuloma.…”

“…In Salzmann’s nodular degeneration, ocular lubricant, warm compression, and a short course of topical steroids are sufficient for patients with mild symptoms [ 9 ]. Surgical intervention, primarily superficial keratectomy, may be required for those with symptomatic nodules obscuring visual axis or refractory cases [ 8 , 9 ].…”