Eye Case of the Week

Question:

This patient presents with transient blurred vision, foreign body sensation and watery eyes. Why?

Answer:

Cogan’s Map-Dot-Fingerprint dystrophy (Epithelial Basement Membrane Dystrophy, EBMD)

Epithelial dystrophy: Basement membrane is thickened and extend into the epithelium (forming map and fingerprint)

Signs:

• Fingerprint lines (fine, relucent, hairlike lines)
• Map lines (thicker than fingerprint lines, more irregular, surrounded by faint haze; resemble irregular coastlines/geographic borders)
• Dots or microcysts (intraepithelial spaces containing debris of epithelial cell that have collapsed and degenerated before reaching epithelial surface)
• Bleb or cobblestone-like pattern
• Often have recurrent epithelial erosions
• May cause irregular astigmatism

Management:

• Educate and warn about recurrent corneal erosion – treat with lubricants
• Recurrent corneal erosions with epithelial defect – treat with chlorsig drops/ointment QID prophylactic
• Address blepharitis and dry eye if needed
• Surgical
  • Epithelial debridement
  • Anterior stromal puncture
  • PTK