Presentation
At the time of initial presentation, he had no history of systemic diseases. [dovepress.com]
There are no pathognomonic histological features of Salzmann nodular degeneration (SND), and the features that are present are also present in other pathologies such as degenerative pannus or corneal scars secondary to inflammation or trauma, requiring [ncbi.nlm.nih.gov]
SND is a foreign body sensation.3 Further, the condition presents bilaterally in 63% of cases.4 Confocal microscopy indicates that these lesions are elongated basal epithelial cells and activated keratocytes, particularly in the area of the anterior [reviewofoptometry.com]
In some cases, superficial keratectomy can easily separate elevated nodular tissue from the corneal surface, leaving Bowman’s layer (where present) untouched. [eyewiki.aao.org]
Atypical Presentation of Salzmann Nodular Corneal Degeneration as a Subepithelial Corneal Dystrophy: A Case Report. Santhiran P, Wan Abdul Halim WH, Yong MH. Santhiran P, et al. [pubmed.ncbi.nlm.nih.gov]
Eyes
- Corneal Irritation
Mechanical disruption of the epithelial-stromal barrier from corneal trauma or surgery and chronic corneal irritation from ocular surface disease like aqueous deficient dry eye may lead to prolonged epithelial wound repair and remodeling and create the [dovepress.com]
Longterm corneal irritation and damage is considered to contribute to over‐repair and nodule formation (Vannas et al. 1975). In most cases, however, there is no history of previous eye disease. [onlinelibrary.wiley.com]
These include It may irritate the ocular surface leading to photophobia Tearing Blepharospasm Secondary recurrent corneal erosions [48] Salzmann’s nodules cause a flattening of the cornea, leading to astigmatism in many cases.[33] Removal of nodules may [ncbi.nlm.nih.gov]
- Hypertensive Retinopathy
Hypertensive Retinopathy Iris and Ciliary Body Lacrimal System Lens Lids Neuro-Ophthalmology Optic Nerve Orbit Retina Sclera Strabismus, Ocular Motility Disorders Systemic Diseases Vitreous Z Videos Z-iPodcasts Z_Op-Videos Endorsed by iPod Podcasting [atlasophthalmology.net]
Skin
- Photosensitivity
The individual was treated with lubrication and presented 5 years later with worsening blurry vision and photosensitivity. [dovepress.com]
Collagen cross-linking involves irradiation of the cornea with UVA irradiation after it has been soaked with riboflavin (vitamin B), a photosensitizer. [aetna.com]
Workup
Clinical examination: A general medical workup is advisable in patients with systemic association of the disease. Examination of eyes should be carried out under slit lamp (bio-microscopy) by an eye specialist. [aimu.us]
Harvey said because these nodules are frequently associated with dry eye, he’ll perform a dry eye workup—Schirmer’s without anesthesia, InflammaDry (Rapid Pathogen Screening, Sarasota, Florida), and tear-breakup time—to determine where the patient stands [eyeworld.org]
Treatment
In these eyes recurrences seem to occur more frequently after treatment. Of 35 eyes documented to have Salzmann's nodular degeneration during the last 15 years in our department, 22 needed PTK treatment. [pubmed.ncbi.nlm.nih.gov]
Here, we’ll review current research about the identification and treatment of SND. [reviewofoptometry.com]
Outline the initial treatment options for Salzmann nodular corneal degeneration. [ncbi.nlm.nih.gov]
Surgical treatment (when indicated) usually results in rapid improvement of visual acuity[4]. Conservative treatment can involve management of the potentially underlying etiology (if known)[9]. [eyewiki.aao.org]
Prognosis
Salzmann’s nodular corneal degeneration (SNCD): Clinical findings, risk factors, prognosis and the role of previous contact lens wear. Cont Lens Anterior Eye. 2011 Aug;34(4):173-8. 4. Fario AA, Halperin GI, Sved N, et al. [reviewofoptometry.com]
This reduces the healing time and improves visual prognosis post-operatively. DSEKs can be used as treatment for conditions such as Fuch’s Endothelial Dystrophy. [lincolneyelaser.com]
Prognosis Prognosis is good with the treatment of underlying factors. Though asymptomatic cases may be observed without progression, cases of spontaneous regression have not been reported. [ncbi.nlm.nih.gov]
Prognosis: Prognosis is very good to excellent. Visual disturbance is relieved by lamellar keratectomy. The condition may recur after surgical excision. [nhp.gov.in]
If identified and treated properly, SND has a positive prognosis. Previously by Dr. [optometrytimes.com]
Etiology
Schwab Medicine Cornea 2010 Salzmann nodular degeneration is a disease of uncertain etiology in which inflammation of the ocular surface may play a role and management with conservative therapy is generally adequate, and in cases that require surgical [semanticscholar.org]
Etiology There has not been a specific causal etiology described to date. [eyewiki.aao.org]
DEPENDING UPON ETIOLOGY A] Age related degeneration:- Arcus senilis, Vogt’s white limbal girdle, Hassal-Henle bodies,Mosaic degeneration. [slideshare.net]
Etiology: Salzmann's nodular degeneration has been associated with trachoma, interstitial keratitis, vernal keratoconjunctivitis, phlyctenular keratoconjunctivitis, ocular trauma, measles, scarlet fever, and previous surgery. [missionforvisionusa.org]
Epidemiology
Dystrophies, Hereditary - metabolism | Disease Progression | Corneal Dystrophies, Hereditary - epidemiology | Aged | Gelsolin - genetics | Mutation | Finland - epidemiology | Amyloidosis - metabolism Journal Article Details Digital rights Loading Rights [query.library.utoronto.ca]
In terms of epidemiology, a wide age range in both men and women has been reported. [remedicajournals.com]
Epidemiology 72%-88% of cases occur in females[10]. SND is more common in Caucasian women in the 6th decade of life but can be seen in both males and females of all ages beginning near adolescence[3][7]. [eyewiki.aao.org]
Summarize the epidemiology of Salzmann nodular corneal degeneration. Outline the initial treatment options for Salzmann nodular corneal degeneration. [ncbi.nlm.nih.gov]
This review will summarize the clinical and histological presentation of SND, its epidemiology and risk factors, diagnostic tools and management strategies, and finally the impact of SND on cataract surgery and co-existing ocular surface disease. [dovepress.com]
Pathophysiology
The exact pathophysiological mechanism leading to SND is unclear but is thought to involve poor epithelial protection secondary to chronic corneal irritation, trauma or surgery, breakdown of Bowman’s layer, activation and anterior migration of fibroblasts [dovepress.com]
Pathophysiology One hypothesis suggests that enzymatic destruction of Bowman’s layer results in migration and proliferation of keratocytes from the posterior stroma, resulting in secondary deposition of extracellular matrix components in nodular areas [eyewiki.aao.org]
Pathophysiology: One of the hypotheses suggests that enzymatic destruction of Bowman’s membrane results in migration and proliferation of keratocytes from the stroma, resulting in secondary deposition of extracellular matrix components in nodular areas [nhp.gov.in]
1p34.3,13pTel-13q12.13, 18q21.2–q21.32, 20p13-p12, 10p11.2 COL8A, SLC4A11, TCF8, TCF4 posterior polymorphous corneal dystrophy AD 20p11.2, 1p34.3-p32.3, 10p11.2 COL8A2, TCF8, OVOL2, GRHL2 Congenital hereditary endothelial dystrophy AR 20p13-p12 SLC4A11 Pathophysiology [en.wikipedia.org]
Prevention
/Avoidable - 0% Emergent - ED Care Needed - Not Preventable/Avoidable - 0% Primary diagnosis of injury 0% Primary diagnosis of mental health problems 0% Primary diagnosis of substance abuse 0% Primary diagnosis of Alcohol 0% Unclassified 100% We Could [medicbind.com]
[…] vision if located centrally Examination: Superficial, elevated multiple blue-white nodules located at corneal midperiphery Treatment Strategy Removal of corneal lesion (superficial keratectomy) Restoring corneal surface integrity by promoting healing and preventing [biotissue.com]
Some have also advocated the concomitant use of mitomycin-C after surgery aimed at preventing an SND recurrence (Bowers et al, 2003). [clspectrum.com]
Ongoing treatment/prevention is aimed at controlling chronic irritation of the eye such as dry eye, blepharitis and meibomian gland dysfunction. [moyeseye.com]