History
An 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 allergies.
Diagnostic Data
Her 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.
Your Diagnosis
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?
Discussion
Additional 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. The diagnosis in this case is senile corneal furrow degeneration with limbal girdle of Vogt.
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. Senile corneal furrow degeneration is unique to the mature population (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.
Differential 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.) We successfully treated our patient with lubrication ointment h.s. and lubricating solutions q4h.
1. Sugar A. Conjunctival and Corneal Degenerations. In: Yanoff M, Duker JS. Ophthalmology. Philadelphia: Mosby, 1999:5.6.1-8.
2. Cohen 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.
3. Rumelt S, Rehany U. Computerized corneal topography of furrow corneal degeneration. J Cataract Refract Surg. 1997 Jul-Aug;23(6):856-9 .
4. Anderson FG Jr. Repair of marginal furrow perforation. Ophthalmic Surg. 1977 Feb;8(1):25-8.
