Corneal DegenerationsApoorva Kottary 28

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Corneal Degenerations

• Degenerative changes in the cornea.• Definition: Corneal degeneration refers to the

conditions in which normal cells undergo some degenerative changes under the influence of age or some pathological condition.

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Distinguished from Corneal Dystrophies

As being:• Non - Hereditary and Non - Familial• Usually Unilateral • Mostly Peripheral• More frequently seen• Vascularity and Inflammation is seen.

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Corneal degenerationsDepending upon etiology

Age - Related

Pathological Degeneration

Depending upon locationAxial

Peripheral

Classification

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Classification• Depending upon Location

I. Axial Corneal Degenerationsa) Fatty Degenerationsb) Hyaline Degenerationsc) Amyloidosisd) Calcific Degenerations (Band

Keratopathy)e) Salzmann’s Nodular Degeneration

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II. Peripheral Degenerationsa) Arcus Senilisb) Vogt’s White Limbal Girdlec) Hassall – Henle Bodiesd) Terriens’s Marginal Degeneratione) Mooren’s Ulcerf) Pellucid Marginal Degenerationg) Furrow Degeneration (Senile

Marginal Degeneration)

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• Depending upon Etiology

I.Age Related Degenerationsa) Arcus Senilisb) Vogts White Limbal Girdlec) Hassal - Henle Bodiesd) Mosaic Degenerations

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II. Pathological Degenerations:

a) Fatty Degenerationb) Amyloidosisc) Calcific Degenerationsd) Salzmann’s Nodular Degeneratione) Terrien’s Marginal Degenerationf) Mooren’s Ulcerg) Pellucid Marginal Degenerationh) Furrow Degenerationsi) Spheroidal Degeneration

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Age Related Corneal Degenerations

Arcus Senilis

Vogt’s White Limbal Girdle

Hassal - Henle Bodies

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Arcus Senilis• It is the annular lipid

infiltrations of the corneal periphery seen in the elderly.• Age – related degeneration occurring bilaterally in 60% of

people aged 40 to 60 years.• And almost all individuals

aged over 80 years.

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Clinical Features• Commences as a crescentric grey or white arc in

the superior and inferior quadrant and progresses to form a ring around the cornea,

• 1mm wide ring• Lucid interval of Vogt’s – the clear zone which

separates the ring of opacity from the limbus.• Peripheral border is sharp and inner border is

diffuse.• Rarely double ring of Arcus is seen.

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Arcus Senilis

Lucid Interval of Vogt’s

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• It is not of importance, as it does not decrease vision or the vitality of the cornea.

• Unrelated to metabolic conditions such as hypercholesterolemia.

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Arcus Juvenilis• Similar to Arcus Senilis but occurs

in individuals aged less than 40 years.

• Rare condition• Associated with

Hypercholesterolemia • Diagnostic feature: Presence of a

line of clear cornea between opacity and limbus.

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Vogt’s White Limbal Girdle

• Age related which appears as a bilateral chalky white opacities in the inter - palpebral area both nasally and temporally.

• Opacity in the Bowman's Membrane.

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Vogt’s White Limbal Girdle

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Vogt’s White Limbal Girdle

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Hassal - Henle Bodies

• Drop shaped excrescences of hyaline material projecting into the anterior chamber around the corneal periphery

• Arise from Descemet’s membrane• Commonest senile change.• In pathological changes, they become larger

and invade the central area and the conditions is called ‘Corneal Guttata’.

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Corneal Guttata

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References1. Parson’s Diseases of the Eye2. Comprehensive Ophthalmology – A.K. Khurana3. Pictures Courtesy – Online Journals

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That’s all folks!Thank you