1

Pterygia

• Etiology: triangular, fibrovascular, connectivetissue overgrowths of bulbar conjunctiva ontocornea; distribution of ultraviolet energy- heat,wind, dust, dry atmosphere,higher prevalencenearer the equator

• Usually horizontally,intrapalpebrally oriented withthe base peripheral and the apex over the cornea

• Asymptomatic to photphobia, tearing, FBsensation, decrease vision by with rule irregularastig.

• Slit lamp: horizontally located in palpebral

fissure, usually nasal side; a grayish, flat

avascular zone lies at apex: a pigment line,

(I.e. Stocker’s line) may be seen in advance

of pterygium; indications for activity are

epithelial staining, opacifications of

Bowman’s membrane, fleshiness and

thickness of vessels

• Treatment: surgical with mask recurrence

as high as 40%; surgical excision with B-

radiation less recurrence and topical

mitomycin C; wearing of eyeglasses to

reduce ultraviolet energy and hats,

conservative attitude toward surgery

• Pseudopterygium- a probe can be passed

between the mass and the globe

2

Senile: flattening of vertical meridian,

thinning of periphery, lack of luster

• White Limbal Girdle of Vogt– Etiology: a degeneration found quite

frequently (60%) in patients over 45, innocuous

– Slit lamp: white, narrow, crescentic, irregular,chalky opacity in temporal and medial limbalareas of Bowman’s, in the interpalpebral zone,no vascularization, vision not affected; arcshape; may or may not be a clear interval

– Two types-- see chart

3

Anterior Mosaic (Crocodile)

Shagreen

• Slit lamp: unknown, bilateral, polygonal,grayish-white opacities separated by cleartissue in the deep areas of the epithelium andBowman’s; usually located axially; visionusually not affected, appearance likened tocrocodile leather, most prominent centrally

• Anterior corneal mosaic pattern- NaFlstained cornea after applying pressure to thecornea through the lid

Posterior Crocodile Shagreen

• Slit lamp: bilateral, grayish-white opacities

in deep stroma and Descemet’s which

appear as small polygonal patches of

various sizes separated by dark regions

4

Cornea Farinata

• Etiology: may be transmitted as an autosomal

dominant trait or may be a manifestation of senile

changes

• Slit lamp: small gray-white, tiny, dustlike dots

and flecks deep in the stroma or pre-Descemet’s

zone, no vascularization; axially diffuse or annular

distribution; farinata refers to “flour-like”

appearance of deposits, visually insignificant

Corneal Arcus Senilus

• Etiology: deposition of cholesterol esters,

triglycerides, and phospholipids in peripheral

stromal cornea; a bilateral, hazy ring in the

peripheral cornea, may be associated with

abnormalities in blood lipids (elevation of

cholesterol and LDLs), especially in younger

persons, risk factor for heart disease(order serum

lipid profile), unilateral suggest vascular occlusion

on side without arcus, most often age related

• Slit lamp: complete or incomplete

perilimbal yellow-white, hazy opacity; clear

perilimbal zone, lipid first noted in

Descemet’s membrane and then Bowman’s

layer, deposits appear first in the inferior

and then the superior and eventually

encircle the entire cornea

5

Hudson Stahli line

• Yellowish brown, narrow, horizontal, single

line of pigmentation seen between the lower

pupil margin and inferior limbus

• Iron deposition occurs with aging, due to

disturbed, epithelial turnover

Descemet’s striae

• Etiology: aging change in the Descemet’s

membrane in an otherwise normal cornea

• Slit lamp: small, fine, linear (usually

vertically oriented) striations which are not

large enough to cause irregularities of

posterior cornea

Hassall-Henle Bodies

• Etiology: peripheral, localized, nodular

thickening of the Descemet’s membrane in

the periphery; considered to be

physiological aging changes

• Slit lamp: same as corneal guttata but are

peripheral; specular reflection as small

circular, dark areas within the normal

endothelial mosaic

6

Dellen

• Etiology: thinning of cornea or sclera due

to tear film abnormalities and dryness

• Slit lamp: localized thin spots that occur in

limbus adjacent to acute elevations of the

conjunctiva