Dimples of the Cornea

𝘋𝘦𝘭𝘭𝘦𝘯⁣ ⁣

● Fuchs described them as saucer like excavations at the periphery of the cornea⁣ ⁣

● Clearly-defined excavations⁣ ⁣

● Temporal side usually⁣ ⁣

● Forming ellipses parallel to the limbus⁣ ⁣

● Paralimbal elevation → localised break in the precorneal oily tear film → localised dehydration and thinning⁣ ⁣

● Focal absence of mucin layer → cornea epithelium is hydrophobic and in absence of mucin will repel water and produce a dry spot → dry epithelial surface → local deturgescence of underlying anterior stroma → overlying epithelium erodes→ defect created⁣ ⁣

● Fluorescein pools in the depression and at times there is overlying staining⁣ ⁣

● Epithelium within the dellen can either be clear or opaque in appearance⁣

⁣ 𝘊𝘢𝘶𝘴𝘦𝘴:⁣ ⁣

1. Following limbal elevation (episcleritis, scleritis, angioma, thick pingecula, pterygium, subconjunctival injections, filtering blebs, suture granuloma, limbal tumours)⁣

2. After cataract surgery/ strabismus surgery⁣

3. Rigid contact lens wear⁣

4. Following paralytic lagophthalmos⁣

5. Spontaneously in elderly persons⁣ ⁣

Treatment involves reduction of the paralimbal elevation and re-establishment of the mucin layer and a hydrophilic surface- Frequent lubrication, Bandage contact lenses, tarsorrhaphy.⁣ ⁣

Image from Rajan Eye Care Hospital⁣

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