Introduction
Background
The cornea plays a crucial and vital role in the visual pathway. To maximize the visual potential of the eye, both the clarity of the cornea and the refractive power (curvature) are important. Any disturbance to the clarity or thickness of the cornea will affect its visual potential. The Descemet membrane and endothelial cells play a critical role.
Pathophysiology
The cornea is composed of 5 discrete anatomical components, each with specific functions to achieve the goal of clarity and refractive potential. The outermost component, the epithelium, provides a smooth surface due to the interactions of cytoskeletal components and tear film matrix. It also serves an important protective barrier function. The Bowman layer or membrane, the second layer moving in toward the eye, serves as the smooth adhesion layer for the basement membrane of the epithelial cells. This layer is not crucial for clarity or visual function since removal of the Bowman layer during photorefractive keratectomy does not negatively affect vision.
The corneal stroma makes up the majority of the width of the cornea. It is composed of collagen fibrils arranged in a regular pattern to allow light to enter and pass through without being diffracted or reflected. Inflammation manifesting as stromal infiltrates and/or stromal edema results in the interruption of the regular periodicity of the collagen matrix and decreased corneal clarity. Because the cornea is avascular, nutrients and wastes are delivered and deposited anteriorly via the tear film and external environment, internally via corneal nerves, and posteriorly via the aqueous humor.
The innermost layer of the cornea is the endothelial cell layer, a monolayer of polarized cells. They are arranged with their apical portion toward the aqueous humor in the anterior chamber. The endothelial cells are responsible for maintaining the desiccation of the stroma by actively removing water. The Descemet membrane is the specialized basement membrane of the endothelial cells positioned between the stroma and the endothelial cell layer. Any condition that causes inflammation of the cornea or the anterior chamber can cause Descemet membrane folds.
Frequency
United States
This condition is common because it is associated with many inflammatory conditions of the eye.
International
Same as in United States.
Mortality/Morbidity
Morbidity due to decreased vision and pain exists.
Race
No predisposition to race exists.
Sex
This condition affects women and men equally.
Age
This condition affects all age groups with slower resolution of the folds in elderly persons.
Clinical
History
- Pain - External-type pain alleviated by topical anesthesia
- Blurry vision - Mild to moderate if only stromal edema; moderate to severe if epithelial edema too; can severely affect vision
- Foreign body sensation – External symptoms alleviated by topical anesthetic
- Tearing due to external symptoms
- Eyelid swelling if corneal edema is severe
Physical
- Descemet folds are directly visible with slit lamp biomicroscopy using direct focal illumination, specular reflection, and retroillumination.
- Descemet folds are associated with corneal edema due to endothelial dysfunction from infections, from infiltrations, or following surgery.
- Descemet folds also are associated with corneal inflammation due to infections or infiltrations or following surgery.
- Descemet folds also are associated with anterior chamber inflammation visible by direct focal illumination.
Causes
- Inflammation due to corneal or ocular infection
- Inflammation after surgery; normal postoperative inflammation or exuberant inflammatory response can be due to complicated surgery, retained lens fragments, retinal detachment, or endophthalmitis.
- Inflammatory conditions, such as blepharitis, phlyctenulosis, episcleritis, and scleritis
- Trauma or injury, such as blunt trauma or acidic/alkaline chemical injury
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References
American Academy of Ophthalmology. External disease and cornea. In: Basic and Clinical Science Course, Section 8. 1999.
Denion E, Dalens PH, Huguet P. Radial Descemet's membrane folds as a sign of pterygium traction. Eye 2004 Sep 3. [Medline].
Medical Economics Company, ed. Physicians Desk Reference. 27th ed. 1999: 223, 243, 252, 254, 265.
Scuderi B, Driussi GB, Chizzolini M. Effectiveness and tolerance of piroxicam 0.5% and diclofenac sodium 0.1% in controlling inflammation after cataract surgery. Eur J Ophthalmol. Jul 2003;13(6):536-40. [Medline].
Wilson FM. Slit-lamp biomicroscopy. In: Practical Ophthalmology. 4th ed. 1996:213-229.
Further Reading
Keywords
Descemet's membrane folds, Descemet's folds, Descemet folds, endothelial folds, endothelial cells, eye inflammation, ocular inflammation, ocular infection, corneal infection, inflammation of the cornea, corneal inflammation, anterior chamber, anterior segment inflammation
