Atypical Presentation of Salzmann Nodule: A Case Report and Literature Review

Abstract

Salzmann's nodular degeneration (SND) is an unusual corneal condition that is slowly progressive and non-inflammatory in nature. It results in millimetric gray-white to bluish nodules formation anterior to Bowman's layer of the cornea. It usually affects both eyes in 80% of the cases. These elevated nodules are located near the limbus or in the mid-peripheral cornea, with some exceptions. Salzmann nodule develops following corneal trauma or inflammation. However, it can present idiopathically. Here, we report an atypical case of idiopathic symptomatic large central SND that was treated successfully with superficial keratectomy.

Keywords: atypical salzmann; central salzmann; literature review; salzmann nodular degeneration; visually significant salzmann.

Figure 1. Slit lamp photo of the left eye showing large central elevated whitish lesion

Figure 2. OCT showing hyper-reflective sub-epithelial lesion anterior to the Bowman's layer

Figure 3. Slit lamp photo of the cornea after excision of the lesion with mild haze

Figure 4. OCT of the cornea after excision of the lesion

Figure 5. Histopathologic examination shows thinning of the corneal epithelial lining with sub-epithelial fibroblastic proliferation and deposition of hyalinized material (hematoxylin and eosin x100)