Pachymetry-induced exacerbation of map-dot-fingerprint dystrophy.

Case report

A 33-year-old male with a history of recurrent corneal erosions presented with decreased vision and pain in the left eye immediately after a visit to optometry. Of note, pachymetry had been performed at that visit as part of a glaucoma suspect workup.

In our office, his visual acuity was 20/30 in the affected eye. Slit lamp examination of the cornea revealed a central non-staining area of intraepithelial cysts and map lines, consistent with map-dot-fingerprint dystrophy. Corneal topography showed corresponding central steepening (Fig. 1A). He was advised regular lubrication. After two weeks, his symptoms resolved, his acuity returned to 20/20, and his corneal topography normalized (Fig. 1B).

Fig. 1

A: Corneal topography on presentation, B: Corneal topography at one month follow-up.

Corneal topography of the left eye on presentation demonstrates a central island of steepening and irregularity likely due to pachymeter tip-induced corneal injury (Fig. 1A). Repeat topography one month later demonstrates resolution (Fig. 1B).

Discussion

Map-dot-fingerprint dystrophy is an inherited corneal epithelial basement membrane dystrophy that presents as recurrent corneal erosions and blurred vision due to reduced adherence of the corneal epithelium to the underlying stroma. Onset of these episodes are usually spontaneous or as a result of traumatic injury to the cornea. Corneal manipulation during ocular surgery and photorefractive surgery including LASIK and PRK can also precipitate attacks; other iatrogenic causes of recurrent corneal erosions in the setting of basement membrane dystrophy have not been as frequently reported.1, 2, 3 This case is notable as it is the first reported case of corneal erosion with background map-dot-fingerprint dystrophy precipitated by pachymetry, which was apparent both on examination findings and corneal topography.

Conclusion

This case is a salient reminder to minimize unnecessary manipulation of the corneal epithelium in patients with known history of basement membrane dystrophy or recurrent corneal erosion syndrome.

Patient consent

Patient consent was obtained to present clinical information and images relating to this case for publication.

Acknowledgements and disclosures

Funding

No funding or grant support.

Conflicts of interest

The following authors have no financial disclosures: MR, RV, YQ.

Authorship

All authors attest that they meet the current ICJME criteria for Authorship.