BASICS

DESCRIPTION

• Small, saucer-like excavation at the corneal margin

• Most often form an ellipse; 2 × 1.5 mm parallel to the limbus

• Associated with adjacent elevation of paralimbal tissue

EPIDEMIOLOGY

Incidence

• 9% after trabeculectomy (1)

• Up to 19% after muscle surgery (2)

RISK FACTORS

Any process causing elevation of the perilimbal tissue

PATHOPHYSIOLOGY

Localized dehydration of the cornea secondary to a localized break in the precorneal oily tear film layer

ETIOLOGY

Elevation of paralimbal tissue leads to a change in the tear film probably by affecting lid function

COMMONLY ASSOCIATED CONDITIONS

• Episcleritis

• Pinguecula

• Pterygium

• Subconjunctival injection

• Glaucoma surgery with creation of a filtering bleb

• Subconjunctival hemorrhage

• Limbal malignancy

• Paralytic lagophthalmus

DIAGNOSIS

HISTORY

• Recent surgery

• Any change in the appearance of the eye

PHYSICAL EXAM

• Apparent corneal thinning evident on slit lamp exam (3)

• Steep wall on the corneal side, sloping wall on the limbal side

• May or may not stain with fluorescein

• Cornea can appear markedly thinned (may resemble a descemetocele without a bulge)

DIFFERENTIAL DIAGNOSIS

• Peripheral ulcerative keratitis

• Corneal ulcer

• Terrien’s marginal degeneration

TREATMENT

MEDICATION

First Line

• Artificial tears, 1 drop q.i.d (3)

• Ointment (antibiotic or tear) q.h.s (3)

Second Line

Topical antibiotic, 1 drop q.i.d (2)

ADDITIONAL TREATMENT

General Measures

• Patching of the involved eye for a day (3)

• Treatment of the cause for the tissue elevation

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Should be seen in a week

PROGNOSIS

• If treated, resolves without sequelae

• May leave scar if present for a prolonged period of time

COMPLICATIONS

• Rarely, severe thinning may occur (4)

• May need surgical intervention (4)

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