Salzmann's Nodular Degeneration

Overview

Salzmann's nodular degeneration appears as a bluish-white mass of elevated nodules on the surface of the cornea (the clear part of the eye). The mass may occur in the mid-periphery of the cornea (in which case it is often asymptomatic as it does not interfere with vision), or centrally (in which case it is likely to impair vision). The condition is often unilateral (occurs in one eye only), although some studies suggest that it is more commonly bilateral. Additionally, Salzmann degeneration is more common in females.

With progression of Salzmann's nodular degeneration, individuals are at increased risk of a condition known as recurrent corneal erosion (RCE). Patients who experience RCE will describe such symptoms as mild to severe pain, light sensitivity, eye twitch, increased tearing, and reduced vision. The conjunctiva (clear membrane covering the white part of the eye) may also become injected (ie. blood vessels will dilate and the eye will appear red).

Patients with Salzmann's nodular degeneration often report some previous episode of ocular inflammation. Examples of such inflammation may result from any of the following: phlyctenular disease, contact lens wear, conjunctivitis, corneal surgery, or trachoma infection. This previous inflammation of the eye often occurs in childhood.

Signs & Symptoms of Salzmann Degeneration

For the most part, patients with Salzmann's nodular degeneration are asymptomatic aside from persistent dry-eye symptoms. These symptoms may be described as grittiness or burning of the eyes. Dry eye symptoms are well managed with artificial tears. An alternative therapy is to use a contact lens as a bandage over the entire cornea. This ensures that the cornea is receiving adequate tear exchange and that there are no areas of dryness adjacent to the elevated nodules.

Detection & Diagnosis of Salzmann Degeneration

In the very early stages of Salzmann's nodular degeneration, the nodules may be so small that they are only detectable by an eye doctor using a specific instrument known as a slit lamp biomicroscope. As the nodules increase in size and number, however, they become evident without magnification.

Treatment of Salzmann's Nodular Degeneration

In the later stages of Salzmann degeneration, patients experiencing RCE may require treatment. Excision of the lesions is currently the standard, which is accomplished by a process known as superficial keratectomy. Phototherapeutic keratectomy (PTK) is an alternative to superficial keratectomy, in which case an excimer laser is used to remove the superficial layers of the cornea (effectively removing the Salzmann nodules). PTK is fast becoming the standard of care and often provides excellent results.

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