Schnyder Corneal Dystrophy Or Another Mystery? Unraveling An Atypical Case Of Progressive Corneal Crystals
Published 2026 - 44th Congress of the ESCRS
Reference: POANT026 | Type: Free paper | DOI: 10.82333/z8sn-ez46
Authors: Dr Aymen Mabrouk* 1 , A/Prof. Hager Ben Amor 1 , Dr sarra El Mansouri 2 , A/Prof. Bechir Jelliti 1 , A/Prof. Moncef Khairallah 1
1ophtalmology,Fattouma Bourguiba University Hospital,Monastir,Tunisia, 2ophtalmology,Fattouma Bourguiba University Hospital,Monastir ,Tunisia
Purpose
We present a complex case of a 42-year-old woman with persistent photophobia and progressive corneal
changes who, following left pterygium left eye removal, was initially misdiagnosed with several conditions, including
Salzmann’s nodular degeneration, before subsequent evaluations raised suspicions of Schnyder corneal dystrophy.
Setting
The patient was evaluated in a specialized ophthalmology outpatient setting with serial examinations performed
from 2021 through 2025.
Methods
A comprehensive ophthalmologic evaluation was conducted, including slit-lamp examination with fluorescein
staining, anterior segment optical coherence tomography (AS-OCT), and detailed laboratory tests to exclude systemic
conditions such as hypercholesterolemia and hypercysteinemia. The patient was managed conservatively with artificial
tears and maintained on regular follow-up, with genetic testing planned for diagnostic confirmation.
Results
Initial findings in 2021 revealed bilateral mid-peripheral corneal whitening (3×2 mm) with positive fluorescein
staining, leading to a preliminary diagnosis of Salzmann’s nodular degeneration. Despite symptomatic improvement with
conservative management, the corneal lesions progressed over four years to display crystalline deposits following an
arcus pattern. AS-OCT demonstrated increasing epithelial hyperreflectivity over time. Laboratory evaluations were
unremarkable for metabolic disorders, prompting a revised diagnosis of suspected Schnyder corneal dystrophy despite
the absence of familial history.
Conclusions
This case highlights the diagnostic complexity in corneal dystrophies with atypical presentations.
Progressive corneal crystalline deposition and the development of an arcus pattern, despite initial management and
negative systemic findings, underscore the importance of long-term monitoring and reconsideration of the diagnosis.
Pending genetic testing, the evolving clinical features support a diagnosis of Schnyder corneal dystrophy, emphasizing
the need for vigilance in similar cases.