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Salzmann’s nodular degeneration: is it still an idiopathic disease? Case report

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Session Details

Session Title: Presented Poster Session: Miscellaneous and Infections

Venue: Poster Village: Pod 3

First Author: : D.Cristóvão PORTUGAL

Co Author(s): :    M. Marques   S. Alves   J. Maia Seco   A. Fernandes Fonseca   H. Nogueira  

Abstract Details


A Case Report of bilateral progressive Salzmann's nodular degeneration (SND) without no obviously associated risk factors. SND is a rare, slowly progressive degenerative disease of the cornea, characterized as noninflammatory, blue-gray, subepithelial nodules, often found in the mid peripheral cornea. It is usually bilateral, most commonly occurring in people aged 50-60 years old, with a female preponderance. Although SND has been associated with a variety of corneal diseases, long term contact lenses use, ocular trauma or surgery, in most cases the origin of Salzmann's nodules is idiopathic.


Instituto de Oftalmologia Dr. Gama Pinto


A healthy 40-year-old woman, first presented for evaluation of white-to-gray peripheral corneal opacities in both eyes with slowly increase, since the last 6-years. She was asymptomatic until last 2 years, since she started complaining of ocular irritation and sometimes dry eye. Her past medical and family history were unremarkable, with no previous history of ocular or systemic diseases, ocular trauma, contact lenses use or previous ocular surgery. Her visual acuity was 20/20 in both eyes without correction. Examination of the anterior segment showed a grayish-white nodular formation in the mid peripheral cornea on the superonasal quadrant of both eyes.


It was performed an anterior segment optical coherence tomography, that showed in both eyes prominent bright white deposits located under the corneal epithelium that extend above the Bowman layer and show a slightly anterior corneal surface elevation. Sequential anterior segment photographs were taken the last 2 years. A diagnosis of bilateral SND was made. As the patient had few symptoms and her visual acuity and refraction remain stable, she was recommended the use of lubricants preservative-free and to initiate topical fluorometholone once a day. It is predicted a six month follow-up.


SDN is a rare degenerative corneal disorder that sometimes is difficult to diagnose as it has some resemblance to other diseases. Its exact physiopathology is yet to be determined. Proper diagnosis is important to adopt the accurate management and treatment. Although the majority of patients respond well to conservative management, severe cases may require surgical intervention that includes superficial keratectomy, which may be combined with phototherapeutic keratectomy, amniotic membrane transplantation or keratoplasty.

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