map-dot-fingerprint dystrophy; corneal epithelial basement membrane dystrophy

Epidemiology

• generally affects adults age 40-70 years

Pathology

• abnormal development of epithelial basement membrane of cornea
• corneal epithelial erosion (recurrent epithelial erosion) may result in blurry vision & eye pain

Clinical manifestations

• most cases are asymptomatic
• tends to occur in both eyes
• blurry vision
• eye pain
  • may be severe
  • may last several days
  • generally worse on awakening in the morning
• photosensitivity
• excessive tearing
• foreign body sensation
• funduscopy:
  • affected epithelium has map-like appearance
  • slightly gray patches look like continents on a map
  • clusters of opaque dots underneath or adjacent to patches
  • irregular basement membrane may form concentric lines in the central cornea resembling fingerprints

Management

• eye pain
  • lubricating eye drops or ointments
  • eye patch
• surgery
  • anterior corneal punctures to allow better adherence of epithelial cells
  • corneal scraping to remove erosions
  • eximer laser to remove surface irregularities

Prognosis:

• erosions usually heal in 3 days, althouth periodic eye pain may last weeks
• flareups generally last a few years, then spontaneously resolve

More general terms

• corneal disease (keratopathy)