Map Dot Fingerprint Dystrophy

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Disease

  • = Epithelial Basement Membrane Dystrophy (EBMD), see Corneal Dystrophies
  • Mostly degenerative or resulting from trauma, rarely autosomal dominant (C1)
  • Onset usually in adulthood

Symptoms

  • Asymptomatic or painful (upon awakening) recurrent epithelial erosions, tearing and visual loss
  • irregular astigmatism due to central changes with visual loss or monocular double vision

Findings

  • isolated or in combination, best visible in retroillumination
  • Map: subepithelial map-like patterns surrounded by a pale haze
  • Dots: dot-like opacities
  • Fingerprint: swirly fingerprint-like lines
  • Epithelial microcysts
  • Frequently recurrent epithelial erosions

Therapy

  • Acute (epithelial erosions): Floxal gtt (ofloxacin) or Tobrex gtt (tobramycin) 3x/d until epithelial closure
  • Lubricating eyedrops (e.g. Lacrycon gtt) 4x/d to hourly + Vitamin A ointment or Bepanthen eye ointment at night for 3-6 months
  • or NaCl 5% 4x/d for 3-6 months
  • if local therapy is not sufficient (loose epithelium and recurrent epithelial erosions):
    • Bandage contact lens for several months (with regular change)
    • Epithelial debridement
    • Consider phototherapeutic keratectomy (PTK)
    • Consider autologous serum eye drops

Sources

  • EyeWiki Epithelial Basement Membrane Dystrophy
  • The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
  • Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)
  • Lisch, Walter & Seitz, Berthold. (2011). Neue internationale Klassifikation der Hornhautdystrophien. Der Ophthalmologe. 108. 883-897. 10.1007/s00347-011-2388-8.