Wessely corneal ring phenomenon: An unsolved pathophysiological dilemma

Ruiz-Lozano, Raúl E.; Salan-Gomez, Marcelo; Rodríguez-García, Alejandro; Quiroga-Garza, Manuel E.; Pérez, Víctor L.; Azar, Nadim S.; Merayo‐Lloves, Jesús; Hernández-Camarena, Julio C.; Valdez-García, Jorge E.

doi:10.1016/j.survophthal.2023.02.009

Cited by 4 publications

(3 citation statements)

References 115 publications

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“…By definition, the ring affects 360 degrees of the peripheral cornea leaving a clear margin from the limbus. In general, the ring appears more often in the peripheral cornea, where the number of antigen-presenting cells surpasses the central cornea [ 7 ]. However, at the disease onset single peripheral infiltrates might be present, then coalescing in a ring-like one [ 8 ].…”

Section: Nomenclaturementioning

confidence: 99%

“…Cornea is a transparent structure, deprived from blood and lymphatic vessels. The ring forms typically close to the limbus, close to the conjunctival vessels, where the ratio of antigen-presenting cells (APC) exceeds the density of APC in the corneal center similarly to C1 concentration [ 7 ]. Bacterial toxins damage host tissues by activating alternate complement pathway via properdin and C3 stimulation.…”

Section: Pathophysiologymentioning

confidence: 99%

“…They were localized in the anterior stroma or subepithelium resembling viral/chlamydial infection and resolving with topical corticosteroids treatment [ 36 ]. Although the exact pathophysiology is unknown, the authors speculate that the ring formation might be linked to residual Acanthamoeba antigens released from the cornea or hypersensitivity reaction to long-lasting treatment (propamidine isethionate) [ 7 ].…”

Section: Infectious Causes Of Corneal Ring Infiltratementioning

confidence: 99%

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Corneal ring infiltrate- far more than Acanthamoeba keratitis: review of pathophysiology, morphology, differential diagnosis and management

Przybek-Skrzypecka,

Skrzypecki,

Suh

et al. 2023

J Ophthal Inflamm Infect

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Objective Ring infiltrates usually accompany numerous infectious and sterile ocular disorders. Nevertheless, systemic conditions, drugs toxicity and contact lens wear may present with corneal ring infiltrate in substantial part. Considering its detrimental effect on vision, detailed knowledge on etiology, pathophysiology, differential diagnosis, and management should be considered essential for every ophthalmologist. Methods The PUBMED database was searched for “corneal ring infiltrate” and “ring infiltrate” phrases, “sterile corneal infiltrate” and “corneal infiltrate”. We analyzed articles written in English on risk factors, pathophysiology, clinical manifestation, morphological features, ancillary tests (anterior-segment optical coherence tomography, corneal scraping, in vivo confocal microscopy), differential diagnosis and management of corneal ring infiltrate. Results Available literature depicts multifactorial origin of corneal ring infiltrate. Dual immunological pathophysiology, involving both antibodies-dependent and -independent complement activation, is underlined. Furthermore, we found that the worldwide most prevalent among non-infectious and infectious ring infiltrates are ring infiltrates related to contact-lens wear and bacterial keratitis respectively. Despite low incidence of Acanthamoeba keratitis, it manifests with corneal ring infiltrate with the highest proportion of the affected patients (one third). However, similar ring infiltrate might appear as a first sign of general diseases manifestation and require targeted treatment. Every corneal ring infiltrate with compromised epithelium should be scraped and treat as an infectious infiltrate until not proven otherwise. Of note, microbiological ulcer might also lead to immunological ring and therefore require anti-inflammatory treatment. Conclusion Corneal ring infiltrate might be triggered not only by ocular infectious and non-infectious factors, but also by systemic conditions. Clinical assessment is crucial for empirical diagnosis. Furthermore, treatment is targeted towards the underlying condition but should begin with anti-infectious regimen until not proven otherwise.

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Section: Nomenclaturementioning

confidence: 99%

Section: Pathophysiologymentioning

confidence: 99%