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Year : 1991  |  Volume : 39  |  Issue : 1  |  Page : 30

Posterior keratoconus due to iron nail injury-A case report

Dr. R. P. Centre for Ophthalmic Sciences, AIMS, New Delhi, India

Correspondence Address:
Umesh Bareja
Dr. R. P. Centre for Ophthalmic Sciences, AIMS, New Delhi
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Source of Support: None, Conflict of Interest: None

PMID: 1894343

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A case of post-traumatic keratoconus is presented. This is an unusual variant of an uncommon disorder. Posterior keratoconus is a very rare ectatic dystrophy of the cornea. Since its first description in 1927, only a few cases have been described in the literature. Posttraumatic posterior keratoconus is a much rarer entity. We are reporting a case of posterior keratoconus caused by iron nail injury.

How to cite this article:
Bareja U, Vajpayee R B. Posterior keratoconus due to iron nail injury-A case report. Indian J Ophthalmol 1991;39:30

How to cite this URL:
Bareja U, Vajpayee R B. Posterior keratoconus due to iron nail injury-A case report. Indian J Ophthalmol [serial online] 1991 [cited 2020 Apr 6];39:30. Available from: http://www.ijo.in/text.asp?1991/39/1/30/24485

  Case report Top

A 30 years old male, carpenter by occupation, presented to the cornea clinic of our centre with complaint of diminution of vision in his right eye of one month dura­tion. A careful history brought the fact that he had sustained an injury caused by an iron nail while fixing a door. He consulted a local ophthalmologist and was prescribed topical gentamicin drops and 1 % atropine ointment. On examination, his visual acuity was OD 6/36 and OS 6/5. The left eye was normal. Slit lamp examina­tion of the right eye showed a paracentral nebulo macular corneal capacity in the anterior stroma [Figure - 1]. A rust ring was present in the centre of the opacity. A posterior keratoconus was seen extending below the area of opacity[Figure - 2]. The anterior curvature of the cornea appeared normal and keratometry showed no distortion of mires. The anterior segment was quiet and fundus was normal.

  Discussion Top

Posterior keratoconus is usually a bilateral, congenital and stationary ectatic dystrophy of the cornea, interfer­ing minimally with vision [5]. However, cases following trauma are, more likely to show diminution of visual acuity due to associated corneal opacities. In the first case described by Jacobs in 1957 [3], the opacity was directly overlying the area of keratoconus. Our case is peculiar in that the area of ectasia of the posterior corneal layers, instead of being directly behind the opacity, lay inferior to it.

Congenital posterior keratoconus is supposed to develop either because of delayed separation of the lens vesicle from the surface ectoderm or improper develop­ment of the central endothelium preventing proper migration of stromal cells [6]. A Fleisher ring has been noted in some cases. [7]

Traumatic posterior keratoconus develops because of the selective dissolution of the posterior corneal layers. The mechanism in such cases may involve an oblique penetrating injury, with more splitting and destruction of the inner corneal layers than the outer. Alternatively, a localized damage to Descemet's membrane on the cor­neal side may be involved. Either mechanism is likely to be modified by later corneal remodelling. [4]

  References Top

Butler, TH. An illustrated guide to the slit lamp London Oxford University Press, 39 : 1927.  Back to cited text no. 1
Jacobs. HB. Posterior conical cornea Br Journal Ophthalmol 41 : 40: 1957.  Back to cited text no. 2
Jacobs, HB. Traumatic keratoconus posticus Br Journal Ophthalmol 41, 40, 1957.  Back to cited text no. 3
Williams R. Acquired posterior keratoconus Br Journal Ophthalmol 52:119, 1961.  Back to cited text no. 4
Karlin DB, Wise GN. Keratoconus posticus. Am Journal Ophthalmol 52 : 119, 1961.  Back to cited text no. 5
Wolter JR, Haney WP & Mich AA. Histopathology of Keratoconus posticus circumscriptus. Arch Ophthalmol 69 : 357, 1963.  Back to cited text no. 6
Krachmer JH, Rodrigues MM. Posterior Keratoconus. Arch Ophthalmol 96 :1967;1978.  Back to cited text no. 7


  [Figure - 1], [Figure - 2]

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