Corneal Epithelium Asymmetry in Children With Atopy: The Effect of Hand Dominance

Loureiro, Tomás; Rodrigues-Barros, Sandra; Carreira, Ana Rita; Gouveia-Moraes, Filipe; Carreira, Pedro; Escada, Ana Vide; Campos, Paul; Machado, Inês; Campos, Nuno; Archer, Timothy J; Reinstein, Dan Z.; Ambrósio, Renato

doi:10.2147/opth.s375504

Cited by 3 publications

(3 citation statements)

References 49 publications

(66 reference statements)

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“…Furthermore, they found more epithelial thinning in the eye which corresponded on the side of the dominant hand. 14 None of these epithelial thickness map patterns are consistent with the one we found in our patient. In addition, the hot spot of epithelial hyperplasia persisted without changes after six months without eye rubbing.…”

Section: Discussionsupporting

confidence: 87%

Epithelial Hyperplasia as a Cause of Irregular Astigmatism: Successful Treatment by Mechanical Removal of the Epithelium Only

Victoria¹,

Juan²,

Adrián³

2023

Preprint

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Background The corneal epithelium remodeling in response to changes in the anterior corneal surface (keratoconus, corneal refractive surgery) is well-documented in the literature. However, several conditions may induce a different behavior of the epithelium, in which focal areas of epithelial thickening induce irregular astigmatism. This case report presents a very unusual case of irregular astigmatism induced by an epithelial hyperplasia of unknown etiology, which was treated by mechanical removal of only the epithelium. Case presentation A 29-year-old woman underwent implantable collamer lens implantation to correct myopia. The patient provided written informed consent. The procedure was uneventful in both eyes. Twenty months later, she complained of decreased visual acuity in the left eye (LE) (uncorrected distance visual acuity (UCDVA) was 20/30; corrected distance visual acuity was 20/20 with + 1.00 -2.25 x 170). Corneal topography revealed a nasal steepening in the LE. Although the corneal thickness map was normal, epithelial thickness mapping revealed a localized nasal area of epithelial hyperplasia in the LE, that matched with the area of steepest curvature. Slit lamp examination showed a total clear cornea with no signs of abnormality. Medical history was unremarkable and a case of epithelial hyperplasia without active inflammation of unknown etiology was considered. The decision was made to perform a mechanical removal of the corneal epithelium after application of diluted alcohol. One month after the procedure, the topography of the epithelized cornea showed a regular bow tie pattern and UCDVA improved to 20/20. No recurrence of the epithelial hyperplasia was detected after eight months. Conclusions Focal epithelial hyperplasia may induce irregular astigmatism. Epithelial thickness mapping is a very helpful technology to assess cases with irregular topography. De-epithelization as an isolated procedure may be useful to manage these cases successfully. Further investigations are required to understand the mechanism that may trigger the spontaneous development of a focal epithelial hyperplasia.

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Section: Discussionsupporting

confidence: 87%

Epithelial Hyperplasia as a Cause of Irregular Astigmatism: Successful Treatment by Mechanical Removal of the Epithelium Only

Victoria¹,

Juan²,

Adrián³

2023

Preprint

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“…The patient reported rubbing her eyes though very rarely. There are few publications regarding the effects of eye rubbing on the corneal epithelium [ 12 – 14 ]. No significant differences in epithelial thickness were found after eye rubbing in one paper [ 12 ], while epithelial thinning changes were described in two other studies [ 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…There are few publications regarding the effects of eye rubbing on the corneal epithelium [ 12 – 14 ]. No significant differences in epithelial thickness were found after eye rubbing in one paper [ 12 ], while epithelial thinning changes were described in two other studies [ 13 , 14 ]. None of these epithelial thinning map patterns are consistent with the localized epithelial thickening we observed in our patient and, in addition, the hot spot of epithelial hyperplasia persisted without changes after six months without eye rubbing.…”

Section: Discussionmentioning

confidence: 99%

Mechanical removal of epithelial hyperplasia leads to successful treatment of irregular astigmatism

Rojas¹,

Toledo²,

Ruibal³

2023

BMC Ophthalmol

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Background Corneal epithelium remodeling in response to changes in the anterior corneal surface (keratoconus, corneal refractive surgery) is well-documented in the literature. However, several conditions may induce a different behavior of the epithelium, in which focal areas of epithelial thickening induce irregular astigmatism. This case report presents a highly unusual case of irregular astigmatism induced by an epithelial hyperplasia of unknown etiology, which was treated by the mechanical removal of only the epithelium. Case presentation A 29-year-old woman underwent implantable collamer lens implantation to correct myopia. The patient provided written informed consent. The procedure was uneventful in both eyes. Twenty months later, she complained of decreased visual acuity in the left eye (uncorrected distance visual acuity (UCDVA) was 20/30; corrected distance visual acuity was 20/20 with + 1.00 -2.25 × 170). Corneal topography revealed a nasal steepening in the left eye. Although the corneal thickness map was normal, epithelial thickness mapping revealed a localized nasal area of epithelial hyperplasia in the left eye that matched the area of steepest curvature. Slit lamp examination showed a total clear cornea with no signs of abnormality. The patient´s medical history was unremarkable and a case of epithelial hyperplasia of unknown etiology, without active inflammation, was considered. The decision was made to perform a mechanical removal of the corneal epithelium after application of diluted alcohol. One month after the procedure, the topography of the epithelized cornea showed a regular bow tie pattern and UCDVA improved to 20/20. No recurrence of the epithelial hyperplasia was detected after twenty-one months. Conclusions Focal epithelial hyperplasia may induce irregular astigmatism. Epithelial thickness mapping is a very helpful technological tool to assess cases with irregular topography. De-epithelization as an isolated procedure may be useful for the successful management of these cases. Further research is required to understand the mechanism that triggers the spontaneous development of a focal epithelial hyperplasia.

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Corneal Epithelial Hyperplasia Related to Chronic Eye Rubbing Mimicking Keratoconus

Pollmann,

Cohen,

Jabbour

2024

Eye &Amp; Contact Lens: Science &Amp; Clinical Practice

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We report a case of corneal epithelial hyperplasia associated with chronic eye rubbing mimicking keratoconus. A 32-year-old man was presented with a 3-year history of suboptimal vision and astigmatism in his left eye. His history was significant for chronic left eye rubbing. The anterior corneal curvature map showed inferior steepening in the left eye; however, other features of ectasia were absent. Corneal epithelium thickness mapping with optical coherence tomography was significant for corresponding epithelial thickening. His corneal imaging remained stable at a 6-month follow-up examination. At month 15—and after cessation of eye rubbing behavior—the vision symptoms, refraction, and corneal imaging had normalized. In conclusion, chronic eye rubbing may cause reversible corneal epithelial hypertrophy. Eye rubbing should be considered in the evaluation of patients presenting with unexplained vision symptoms and changes in astigmatism that are not consistent with ectasia on corneal imaging.

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Corneal Epithelium Asymmetry in Children With Atopy: The Effect of Hand Dominance

Cited by 3 publications

References 49 publications

Epithelial Hyperplasia as a Cause of Irregular Astigmatism: Successful Treatment by Mechanical Removal of the Epithelium Only

Epithelial Hyperplasia as a Cause of Irregular Astigmatism: Successful Treatment by Mechanical Removal of the Epithelium Only

Mechanical removal of epithelial hyperplasia leads to successful treatment of irregular astigmatism

Corneal Epithelial Hyperplasia Related to Chronic Eye Rubbing Mimicking Keratoconus

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