Punctate keratopathy of West Indians.

Clinical Features (Fig. 1, overleaf) The condition appears to be asymptomatic and presents as a chance clinical finding. The corneal lesions are round, discrete dense opacities 0 5 mm. or less in diameter. They lie at the level of Bowman's membrane and usually extend just into the superficial stroma. The typical lesion has a striking white or creamy, rather porous-looking centre, and this is surrounded by a pale halo which merges with the adjacent cornea. The centres have a hard, almost chalk-like quality. The overlying epithelium appears normal clinically and does not stain with fluorescein or Bengal rose. While most of the opacities conform to this description a few have a less well-defined centre while in others the surrounding halo is not so obvious. The lesions do not bear any fixed relationship to corneal nerves. The condition may affect one or both eyes and the lesions may be single or multiple; one patient had thirteen on one cornea. The opacities may occur on all parts of the cornea but are rather more common on the lower half. Corneal sensation is normal. The lids, conjunctiva, limbus, anterior uvea, media, and fundus show no consistent abnormality. This condition has been studied in 26 patients, 20 men and six women; their ages were between 21 and 56 years (mean 37). All are Caribbean immigrants, originating from all parts of the former British West Indies. They attended hospital for a wide variety of complaints, including conjunctivitis, uveitis, glaucoma, trauma, pterygium, megalocornea, chalazion, and refractive errors. It has not been possible to associate the keratopathy with any specific ocular or systemic disease. The lesions do not appear to cause symptoms and in no case have they been responsible for visual disturbance. Two patients gave a history of trauma to the affected eye in childhood, one by a thorn, the other by a piece of wood. One patient was aware of the condition and he knew the opacities had been present for 20 years; his opacities resembled others of uncertain duration. Some patients had been followed for up to 18 months during which time the opacities remained unchanged. The serum cholesterol is within normal limits.