83-year-old white female presented for a
routine eye examination. Her ocular history was noncontributory. Her systemic
history was remarkable for rheumatoid arthritis (RA). She reported no known
best-corrected visual acuity was 20/25 O.U. at distance and near. External
examination was normal, with no evidence of afferent pupillary defect.
Intraocular pressure measured 15mm Hg O.U. Her dilated fundus examination was
normal. The pertinent biomicroscopy findings are illustrated in the photograph.
How would you approach this case? Does this patient
require any additional tests? What is your diagnosis? How would you manage this
patient? What’s the likely prognosis?
testing may include topography, sodium fluorescein staining to quantify areas
of thinning, extended slit lamp examination to rule out corneal melt, and
inspection of the anterior chamber and vitreous to rule out signs of iritis as
well as pars planitis.
diagnosis in this case is senile corneal furrow degeneration with limbal girdle
Furrow degeneration is a peripheral thinning of the corneal tissue
that occurs in the limbal region of elderly patients.1,2 It is
considered a rare, true thinning—with no inflammation, vascularization or
induced corneal astigmatism.
corneal furrow degeneration is unique to the mature
(patients 70 years of age and older). Management may be as simple as
monitoring. However, in cases that are syptomatic or when the region of
the furrow is larger than 5mm, lubrication therapy and/or punctal occlusion can
be used to increase the lacrimal lake and tear film.
diagnoses for corneal furrow degeneration include dellen formation, Terrien’s
marginal degeneration, marginal pellucid degeneration, thinning from
keratoconus, marginal peripheral corneal ulceration and keratolysis (corneal
melt).1-4 (Most of these conditions include moderate to severe
hyperemia, corneal infiltration by white blood cells, and pain.)
successfully treated our patient with lubrication ointment h.s. and lubricating
A. Conjunctival and Corneal Degenerations. In: Yanoff M, Duker JS.
Ophthalmology. Philadelphia: Mosby, 1999:5.6.1-8.
EJ, Rapuano CJ, Laibson PR, Raber IM. Cornea: Peripheral Corneal Thinning.
In: Rhee DA, Pyfer MA. The Wills Eye Manual, 3rd ed. Philadelphia:
Lippincott, William and Wilkins, 1999:97-101.
Rumelt S, Rehany U. Computerized corneal topography of furrow corneal
J Cataract Refract Surg. 1997
4. Anderson FG Jr. Repair
of marginal furrow perforation.