Whorl-like Pigmented Corneal Deposits in a Patient with Severe Atopic Keratoconjunctivitis
Narrative Responses:
Purpose
A case report of a 48 year old male who presented with a two year history of photophobia, redness and tearing. The patient was noted to have significant atopic dermatitis. In addition to the typical inflammatory picture of atopic keratoconjunctivitis, he had whorl-like pigmented deposits in his corneas
Methods
Chart review of a patient with a recurrent two year history of ocular irritation, blurry vision and debilitating photophobia. He had been treated previously with topical agents in another institution, without noticeable improvement. Physical exam revealed signs of eczematous changes on the extensor surfaces of the extremities and scaly, leathery upper and lower eyelids. In addition to fine papillae in the superior and inferior tarsus, the corneal epithelium was rough with bilateral whorl-like sub-epithelial deposits. The patient had an underlying ocular melanosis, and denies taking any medications that result in corneal whorl-like deposits.
Results
The patient was started on topical steroids, a mast cell stabilizer/anti-histamine and cyclosporine 0.05% in addition to frequent preservative free lubricants. The patient's vision improved as the ocular inflammation subsided. The corneal whorl-like deposits remained unchanged. The patient was also referred to a dermatologist to manage his systemic atopic disease.
Conclusion
There are several well documented ocular findings in atopic disease. Most of which result from chronic inflammation of the conjunctiva and cornea. Whorl-like pigmented corneal deposits are another finding that may occur in chronic atopic keratoconjunctivitis. These deposits do not appear to be visually significant.