Oil droplets!
Spheroidal degeneration
Degeneration of cornea/conjunctiva
Homogeneous,translucent,fine,golden yellow spherules/globules of varying size
Aka Climatic droplet keratopathy/ Actinic keratopathy/Bietti’s band-shaped
nodular dystrophy/ Labrador Keratopathy
Risk factors
Old age, UV light (Most common), dry eyes, malnutrition,Corneal trauma from wind, sand, low humidity & extreme temperatures, Welding burns
Pathology
Light microscopy:extracellular deposits in different sizes & shapes, such as spherical, elongated, or angular, in subepithelium, Bowman membrane, & superficial stroma of cornea
Epithelium & basement membrane are affected only in advanced stages, during which Bowman's membrane is often disrupted or absent locally
Light microscopy:lesions stain blue-green with toluidine blue, bright red with methyl green-pyronin,variable pink with Gomori’s aldehyde fuchsin (demonstrates collagenous component),stains eosinophilic with H&E
Electron microscopy:finely granular structures are collected on bands of collagen
Pathophysiology
Source of proteinaceous material forming the droplets: diffusion of serum proteins- Igs and albumins from limbal vessels to the cornea as a result of interaction with UV light
Deposits are secretory products of the epithelium/stroma, which contain incomplete collagen or degraded stromal collagen
Physical irritation to corneal surface from environment, sand, UV light, wind & welding burns have been associated with development & progression
Symptoms
Reduced vision if lesions involve central cornea
Examination
Yellow or golden spherules or droplets at or beneath the epithelium
Located in superficial stroma, Bowman’s membrane and subepithelium,epithelium in advanced cases
Management
Limit sun exposure
Only severe cases affecting vision need Rx - superficial keratectomy,phototherapeutic keratectomy,lamellar keratoplasty,or PK in most severe cases
Complications
Elevated lesions complications-epithelial defects, recurrent corneal erosions, or sterile ulceration
Possible reduced corneal sensation because of deposits-sterile ulcerations can progress to microbial keratitis/perforate rapidly
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