Lipid corneal dystrophy

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Introduction

  • Cause : lipid deposition in the cornea may occur:
    • As a primary problem related to lipid handling by keratocytes.
    • As a problem secondary to a circulating lipid disorder.
    • As a problem secondary to pre-existing corneal pathology.
  • Signs : corneal opacity.
  • Diagnosis : ophthalmology/slit lamp biomicroscopy.
  • Treatment : dietary manipulation to reduce the speed of lesion progression. Superficial keratectomy to remove lipid deposits in severe cases.
  • Lipid deposition in the cornea may be classed as:
    • Lipid keratopathy Rough Collie male 3 yearsFig.1 Lipid keratopathy Rough Collie male 3 years
      Corneal lipid dystrophy (Fig. 1) (bilateral inherited disease with no predisposing systemic or local cause).
    • Lipid keratopathy Pug 13 monthsFig.2 Lipid keratopathy Pug 13 months
      Lipid keratopathy (Fig. 2) (lipid deposition in site of pre-existing corneal pathology, especially vascularization).
    • Corneal arcus deposition next to a limbal mass.
    • Arcus lipoides corneae with systemic elevated plasma lipid.

Diagnosis

Clinical signs

  • Corneal opacity.
  • Ophthalmic appearance.

Differential diagnosis

  • Lipid deposition may be:
    • Associated with another ocular surface pathology - lipid keratopathy.
    • Associated with circulating lipid abnormalities - arcus lipoides corneae.

Outcomes

Prognosis

  • In most cases, lipid deposition is not severe enough to compromise vision and thus prognosis for long-standing ocular health is good.

Reasons for treatment failure

  • In some cases lipid deposition does compromise vision. Here full thickness keratopathy may be useful although this is rarely available.
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