|Year : 1975 | Volume
| Issue : 2 | Page : 31-32
A case of immune ring of the cornea
EC Narasimha, K Anand Kannan
E C Narasimha
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Narasimha E C, Kannan K A. A case of immune ring of the cornea. Indian J Ophthalmol 1975;23:31-2
A case of immune ring of cornea is being presented because of its rarity.
| Case History|| |
A 9 year old female patient was admitted with the complaints of photophobia right eye 2 months duration and white opacity in the right eye of one month duration. She had an attack of redness and watering right eye 3 months back which subsided without any treatment after 5 days. The present complaint of white opacity was noticed accidentally a month back.
On examination, the right palpebral fissure was narrow, there was circumcorneal congestion and a circular ring shaped opacity of 1mm wide situated in the cornea about 2mm from the limbos alround. There were a few nebulae on the centre of the cornea which were not taking up stain with fluroscein. There was superficial type of vascularisation more in the upper half approaching towards the circular opacity. Slit lamp examination revealed that the depth of the opacity extended into the epithelium and superficial lamellae of the substantia propria. The corneal sensation was absent over the site of central nebulae and diminished in other areas. The anterior chamber was deep and the pupil was reacting briskly to light. Tension was 17.3mm Hg. (Schiodz) and visual acuity was 6/9. Fundus was normal. The left eye was clinically normal with visual acuity of 6/6.
Systemic examination revealed no abnormality Invetigations were non contributory.
The diagnosis of immune ring of the cornea was thought of and she was put on local mydriatics and cortisone. Systemically she was given prednisolone 10 mgms daily. In a period of two weeks the photophobia disappeared completely. The circular ring opacity started clearing gradually. She was discharged at her request with the advice to continue the therapy and report after one month.
| Discussion|| |
Localised affections of the cornea may occur with ring shaped structures concentric to a circumscribed primary focus of infiltration and oedema. The rings or ring fragments may be essentially concentric to the primary focus. The rings may not arise simultaneously with the original focus but later in the course of the disease and are due to true stromal reaction. They disappear when the primary focus resolves.
Microscopically these ring reactions correspond with the areas of swollen keratocytes and accumulated lymphocytes. The primary lesion seems to furnish the antigens. The formation of antibodies takes 9 days and the subsequent antigen antibody interactions take place in zones concentric with the focus from which antigen is liberated.
The minimum ring may be confused with two common bilateral corneal conditions of posterior and anterior embryotoxon. In posterior embryotoxon the ring shaped opacity represents the thickened and axially displaced anterior border ring of Schawalbe. It is made up of hypertrophied collagen of the anterior border ring. In anterior embryotoxon the opacity has an internal and external margins anteriorly but posteriorly it extends out as far as Schwable's line. The arcus is broader and the margins are less sharply defined.
The other ring shaped disorders of the cornea such as coat's white ring, annular heredo-dystrophy of the corneal endothelium and the ring shaped deposits associated with hereditary spherocytosis.
The immune stromal rings are seen after herpes simplex, and herpes zoster keratitis.
| Summary|| |
A case of immune ring of the cornea with central nebulae has been described.
We wish to express our thanks to the Superintendent, Government Ophthalmic Hospital, Madras for permitting us to publish this case report.
| References|| |
A.C. Breebart M.D., 1963, Amer. J.Ophthal.
A.J. Bron, 1969, Brit. J. Ophthal.
Duke-Elder, 1965, System of Ophthalmology,
Hogan, M.J. and Zimmer man L E., 1962, Ophthalmic Pathology,
[Figure - 1], [Figure - 2], [Figure - 3]