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First Author: P.Durán-Pérez SPAIN
Co Author(s): N. Barnils-García N. Planas-Domenech E. Puigventós-Rosanas
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To report a case of an earlier stage of terriens disease in a child presenting signs of unilateral Terrien Marginal degeneration.
Hospital Sant Joan de Déu is a tertiary pediatrics hospital located in Barcelona (Spain), which aims to provide integral care for children. It services patients of pediatrics and teenage age from the surrounding Barcelona area and complex cases referred from the rest of Catalonia and Spain. The ophthalmology service is divided into subspecialities to better fit the needs of the patient.
A 12-year-old girl presented with red eye and foreign body sensation in her left eye at the time of consultation in the ocular surface unit. No significant previous medical or ocular history was recorded -and in particular, there was no history of blepharitis, collagen vascular disease, contact lens wear or herpetic disease. Best-corrected visual acuities (BCVAs) were 20/20 in her right eye (RE) and 20/20 in her left eye (LE). Biomicroscopy of the RE was unremarkable, with no evidence of superior or inferior peripheral corneal thinning. Her LE showed ciliary congestion, generalised superior corneal thinning without epithelial defect, and superficial corneal vascularisation associated to secondary lipid keratopathy. Intraocular pressure measured 14 mm Hg (RE) and 13 mm Hg (LE), respectively. Fundus examination of both eyes was unremarkable.
Manifest refraction was +0,75/-1,00x180ẃ in RE and +0,75/-1,00x165ẃ in LE. Keratometric measurements were43,75x44,75 diopters in RE and 44,25x45,25 diopters in LE. Corneal topographic map revealed flattening of the temporal superior peripheral cornea in LE. The central corneal topography was relatively spherical because the area of thinning was small. We performed an optical coherence tomography (OCT) (3D OCT2000 spectral domain) to observe the peripheral corneal. Peripheral corneal thinning was detected between 11 oclock and 3 oclock, consistent with the findings of slit-lamp examination.
Terrien marginal degeneration is classically described as a disease of middle to late years, yet our case might suggest that this condition remains silent for years before being noticed or the patient demands ophthalmological consultation. This case shows that the clinical disease can present itself in children and must be taken into account for differential diagnosis in an ophthalmopediatric environment.