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Salzmann’s Nodular Degeneration

OVERVIEW

For an unknown reason, some eyes develop one or more creamy white nodular elevations called Salzmann’s nodules. These are often mild and located at the edge of the cornea, not causing any symptoms, and can simply be followed. However, if the nodules are larger or more central, they may cause irritation and/or decreased vision.

Lubrication, glasses, or contact lenses may be helpful. Occasionally surgical excision is warranted. Salzmann’s nodules can be removed with a blade or with an excimer laser (phototherapeutic keratectomy or PTK) with good success. The nodules sometimes recur after excision. The use of the anti-scarring agent mitomycin-C at the time of the procedure is believed to reduce the frequency and severity of recurrences.

DEFINITION

Single or multiple creamy white nodular elevations of the cornea. While they tend to start in the periphery, then can expand centrally.

SYMPTOMS

Mild peripheral cases often asymptomatic. More advanced cases cause decreased or distorted vision with possible multiple or shadow images. Occasionally causes foreign body sensation and rarely pain.

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CAUSES

Unknown

RISK FACTORS

Female sex. Possibly epithelial basement membrane dystrophy.

COMPLICATIONS

Very elevated Salzmann’s lesions can cause corneal erosions which can predispose to corneal infections which can lead to corneal scarring and poor vison.

TESTS AND DIAGNOSIS

The diagnosis can usually be made by slit lamp examination. Ancillary testing includes corneal curvature and thickness mapping (corneal topography and tomography) and measurement of the corneal thickness (pachymetry). Anterior segment optical coherence tomography (AS-OCT) may also be helpful.

TREATMENT

Lubrication, glasses, or contact lenses may be helpful. Occasionally surgical excision is warranted. Salzmann’s nodules can be removed with a blade or with an excimer laser (phototherapeutic keratectomy or PTK) with good success. The nodules sometimes recur after excision. The use of the anti-scarring agent mitomycin-C at the time of the procedure is believed to reduce the frequency and severity of recurrences. Rarely, corneal transplantation (either partial thickness or full thickness) may be required.

PREVENTION

The key to prevention of future erosions is lubrication every night for at least 3-6 months.

 

Wills Eye Cornea Specialists

 

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