.188 / Diseases of the DYSTROPHY: bilateral and (usually autosomal dominant).Early in to any systemic or local disease, or DYSTROPHIES (EPITHELIUM ’S MEMBRANE).• Probably, the more common dystrophies, but due to variable presentation• Most of the patients remain asymptomatic, but the recurrent corneal erosions• All are autosomal dominant inheritanceCOMMON VARIETIESMap-dot-fingerprint dystrophy (Cogan’s microcystic).• Variety of microcysts, dots, fingerprint or map-like (Figs and B)• May occur singly or in combination and best appreciated illumination or sclerotic scatter• Patient may present with signs of bilateral recurrent (Fig. )Treatment is often required for recurrent corneal erosions substitutes and BCLCorneal Dystrophies / 189Fig. : Map-dot-fingerprint dystrophyFig. : Map-dot-fingerprint dystrophy—.sclerotic / Diseases of the CorneaFig. : Map-dot-fingerprint dystrophy—with erosionMeesmann dystrophy.• Very rare and innocuous condition.• Tiny epithelial cysts all over the cornea and more interpalpebral areas (Figs and B)• They are best visible by retroillumination or by sclerotic scatter.(Fig. ), otherwise they appear gray (Fig. )• No treatment is necessaryReis-Buckler’s dystrophy.• Relatively common, bilateral condition with inheritance• Reduced visual acuity in second or third decade• Ring-shaped subepithelial opacities giving ‘honeycomb’.appearance (Figs and B)• The entire cornea is affected with more involvement of area (Figs and D).Corneal Dystrophies / 191Fig. : Meesmann dystrophyFig. : Meesmann dystrophy—slit section. | 188 / Diseases of the Cornea CORNEAL DYSTROPHY: FEATURES 1. 2. 3. 4. 5. 6. Usually bilateral and symmetrical Located centrally No vascularization Hereditary (usually autosomal dominant) Early in onset Unrelated to any systemic or local disease, or condition. ANTERIOR DYSTROPHIES (EPITHELIUM AND BOWMAN’S MEMBRANE) • Probably, the more common dystrophies, but frequently misdiagnosed due to variable presentation. • Most of the patients remain asymptomatic, but the others develop recurrent corneal erosions. • All are autosomal dominant inheritance. COMMON VARIETIES Map-dot-fingerprint dystrophy (Cogan’s microcystic) • Variety of microcysts, dots, fingerprint or map-like epithelial lesions (Figs and B). • May occur singly or in combination and best appreciated in oblique illumination or sclerotic scatter. • Patient may present with signs of bilateral recurrent corneal erosions (Fig. ). Treatment is often required for recurrent corneal erosions by tear substitutes and BCL. Corneal Dystrophies / 189 Fig. : Map-dot-fingerprint dystrophy Fig. : Map-dot-fingerprint dystrophy— sclerotic scatter 190 / Diseases of the Cornea Fig. : Map-dot-fingerprint dystrophy—with erosion Meesmann dystrophy • Very rare and innocuous condition • Tiny epithelial cysts all over the cornea and more numerous in interpalpebral areas (Figs and B). • They are best visible by retroillumination or by sclerotic scatter (Fig. ), otherwise they appear gray (Fig. ). • No treatment is necessary. Reis-Buckler’s dystrophy • Relatively common, bilateral condition with autosomal dominant inheritance. • Reduced visual acuity in second or third decade. • Ring-shaped subepithelial opacities giving ‘honeycomb’ appearance (Figs and B). • The entire cornea is affected with more involvement of the central area (Figs and D) Corneal Dystrophies / 191 Fig. : Meesmann dystrophy Fig. : Meesmann dystrophy—slit .
