Prominent protuberances: A peep over corneal striae

A 4-year-old man showed recent binocular (BE) visual impairment, pain, and redness. He had been taking topical steroids for two years because of allergic conjunctivitis. On the test, uncorrected visual acuity was 20/120 and 20/200 for the right eye (RE) and left eye (LE), respectively. BE SLE showed conjunctival congestion and upper tarsal papillae. Corneal findings of microcystic epithelium and interstitial edema (LE> RE) were recorded with horizontal muscle and posterior corneal pigmented bands. The fundus showed almost perfect cupping in BE. BE's IOP was 32mmHg. The child was born by caesarean section at maturity, with a history of benign birth and development. The expression was asymmetrical. The keratometry value does not indicate the inclination of the cornea. Front eye optical coherence tomography (ASOCT) of RE showed hyperreflexive Descemet's membrane (DM) with prominent endothelial protrusions, and the left eye showed local stromal thickening with endothelial protrusions. The patient's eyesight and intraocular pressure improved when he started treatment with anti-glaucoma drugs. Here we list some clinically similar differences in the corneal band structure. The herbal muscles found in congenital glaucoma have torn edges of the DM, thickly wavy, and the areas in between are thin and smooth. Posterior polymorphic corneal dystrophy (PPCD) shows thickened DM with jagged and irregular boundaries. Due to changes in dystrophy endothelial cells, PPCD may be associated with characteristic vesicles. Traumatic DM rupture, which is frequently observed with forceps delivery, may be associated with secondary corneal edema. Interestingly, such streaks are oriented vertically or diagonally to the horizontal streaks of congenital glaucoma. In the eye with severe keratitis, the entry of aqueous water into the stroma through the torn DM rounds the edges of the DM and makes corneal edema prominent. In this case, ancillary diagnostic modality such as ASOCT was added to the dilemma and challenged because hyperreflexive DM was revealed along with ovulation in both congenital glaucoma and PPCD.

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