Salzmann’s Nodular Degeneration
Salzmann’s nodules, also known as Salzmann’s degeneration or Salzmann’s corneal nodular degeneration, is a relatively uncommon eye condition that affects the cornea, the transparent front surface of the eye. Salzmann’s nodules are characterized by the formation of small, elevated, and often translucent nodules on the cornea (Image 1).
These nodules typically develop between the superficial layer of the cornea, called the epithelium; and the middle layer of the cornea, called the stroma (Image 2). They are usually painless, however sometimes they cause a foreign body sensation with blinking. Contact lens wearers may also note more awareness of their lens when its in the eye. The nodules can vary in size and may range from being barely noticeable to causing visual disturbances and discomfort. They can also cause visual distortions to occur, particularly if they are located in the center of the cornea (Image 3).
While the exact cause of Salzmann’s nodules is not always clear, usually they are attributed to chronic irritation. Inflammatory conditions, such as keratitis (corneal inflammation), or autoimmune diseases, can also play a role in the development of these nodules. Degenerative changes in the cornea’s collagen fibers and other structural components over time may contribute to the formation of these nodules as well.
Diagnosing Salzmann’s nodules involves a comprehensive eye examination by an ophthalmologist. During our exam, we will assess the appearance of the cornea, its thickness, and the characteristics of the nodules. Corneal topography (Image 4) and anterior segment OCT (Image 2) may be used to gather more information about the nodules’ location, size, and impact on vision. It’s important to differentiate Salzmann’s nodules from other corneal conditions that may have similar clinical features.
The management of Salzmann’s nodules depends on the severity of the condition and its impact on visual function. In cases where the nodules are small and not causing significant visual disturbance, conservative management may involve lubricating eye drops or ointments to alleviate any discomfort. In more severe cases, where the nodules are affecting vision or causing discomfort, surgical intervention called a superficial keratectomy might be considered. If the nodule extends into the corneal stroma, complete removal may not be possible without more significant surgical intervention.
In a superficial keratectomy, the corneal epithelium overlying the nodule is first removed. The Salzmann’s nodule is then peeled off the surface of the eye. A bandage contact lens and antibiotic drops are often placed to protect eye after the surgery. This procedure can be done in the office but is usually done in the operating room with light anesthesia to make the patient comfortable. There is no pain expected during the procedure, however depending on the size of the nodule, there may be some moderate discomfort while the eye heals over the next few weeks.
While Salzmann’s nodules can be a source of concern for those affected, advances in diagnostic techniques and surgical approaches have improved the management of this condition. Regular eye check-ups, especially for individuals with a history of corneal trauma or inflammation, can aid in early detection and prompt intervention if necessary.
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