Enlargement of the cornea associated with breaks in Descemet membrane (Haab striae) is commonly found in childhood glaucoma patients who had onset of IOP elevation before the age of 4 years. Glaucomas associated with other corneal abnormalities are described in Chapters 10 and 11. Punctate epithelial defects, especially in the inferonasal interpalpebral region, are often indicative of medication toxicity. Microcystic epithelial edema is commonly associated with severely elevated IOP, particularly when the IOP increase is acute. The following corneal endothelial abnormalities can provide important clues to underlying conditions in secondary IOP elevation or glaucoma:
Krukenberg spindle in pigment dispersion syndrome
deposition of exfoliation material in pseudoexfoliation syndrome
keratic precipitates (KPs) in uveitis, especially pancorneal stellate KPs associated with herpesvirus infections
irregular and vesicular lesions in posterior polymorphous dystrophy
a “beaten bronze” appearance in iridocorneal endothelial syndrome
The clinician should note the presence of traumatic or surgical corneal scars. The central corneal thickness of all patients suspected of having glaucoma should be assessed by corneal pachymetry, as a thin central cornea is a risk factor for glaucoma and results in underestimation of IOP by most tonometers (see Chapters 2 and 7).
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.