Friday, April 10, 2009

Corneal Pigmentation – Decoded


Corneal Pigmentation

Type of Pigment Name of Deposit Disorder Location in Cornea
Iron Stocker’s line Pterygium Epithelium
Hudson-Stahli line In old age Epithelium
Ferry’s line Filtering bleb Epithelium
Fleischer’s ring Keratoconus Epithelium
Coat’s white ring Previous Metallic foreign body injury Bowman’s layer 
Siderosis Stroma
Blood staining of cornea Stroma
Copper Kayser-Fleischer ring Wilsons’s Disease Descement’s membrane
Melanin Krukenberg’s spindle Pigment dispersion syndrome Endothelium
Silver Argyrosis Stroma
Gold Chrysiasis Stroma

Stockers line:

  • Iron deposition line in the corneal epithelium, located at the corneal leading edge of a pterygium.
  • present at the leading edge of non-growing pterygium
  • yellow to golden brown.

stocker's line

Hudson-stahli line:

  • Iron deposition line in the corneal epithelium, which commonly seen in the junction between middle and lower third cornea (corresponding to the line of lid closure).
  • Often seen in elderly.
  • bilateral & symmetric
  • Causes no symptoms or clinical significance.

hudson stahli line

Ferry’s line:

  • Seen in front of filtering bleb in glaucoma.
  • Filtering bleb is a blister of conjunctiva resulting from glaucoma surgery by which a flap of sclera is created in the eye wall, allowing aqueous humor to percolate out of the eye and underneath the conjunctiva, thus lowering intraocular pressure. To know more about it, check this MedRounds link.

ferry's line

Coat's White Ring:

  • A form of iron deposit at the level of Bowman's layer.
  • Clinical features:
    • Asymptomatic
    • Small, granular, oval white ring
    • Commonly associated with previous corneal foreign body injury
  • Requires no treatment.

coats white ring

Fleischer Ring :

  • Partial or complete iron deposition ring in deep epithelium encircling the base of the cone.
  • Formed when hemosiderin (iron) pigment is deposited deep in the epithelium
  • Characteristic in eyes with keratoconus.

fleischer ring

Kayser-Fleischer ring:

  • Deposits of copper producing golden-brown discoloration in the peripheral cornea. Their earliest appearance consists of colored crescents at the superior and inferior quadrants of the cornea that eventually become circumferential.
  • The Kayser-Fleischer ring is the single most important diagnostic sign in Wilson's disease
  • It is found in 95% of patients.
  • Virtually all patients with Kayser-Fleischer rings have neurological manifestations.
  • Diseases associated with Kayser-Fleischer rings
    1. Wilson's disease
    2. primary biliary cirrhosis
    3. chronic cholestasis
    4. cryptogenic cirrhosis

kayser fleischer ring

Krukenberg’s spindle:

  • a vertically oriented deposition of pigment on the posterior endothelial surface of cornea.
  • Seen in Pigment dispersion syndrome.
  • In Pigment dispersion syndrome, the iris is bowed posteriorly causing it to rub against the lens zonules. this results in the loss of pigment epithelium& hence the transillumination and the endothelium deposition of pigment. The vertical orientation of pigment is due to conventional current.
  • Pigment granule accumulation in the trabecular meshwork then leads to progressive trabecular dysfunction and ocular hypertension with or without associated glaucomatous optic neuropathy.About 1/3 of them develop pigmentary glaucoma.
  • The classic triad of clinical signs of PDS consists of a
    1. Krukenberg spindle,
    2. slit-like, radial, mid-peripheral iris transillumination defects, and
    3. pigment deposition on the trabecular meshwork (Sampaolesi’s line)

krukenberg spindlepigment dispersion syndrome


Anonymous said...


Anonymous said...

Thank for this marvellous summary!

Anonymous said...

very helpful!

Anonymous said...

very informative

jainendra said...

very good collection

Anonymous said...


Anonymous said...

great resource!

Anonymous said...

Thank you so much! This is great! and the photos are awesome! I actually had a hard time finding some of them until I visited your site. Great Study website!!

Anonymous said...

Great information!

Anonymous said...

excellent collection

Anonymous said...

REALLY helpful thanks :)

Anonymous said...

Thank you very much!

Anonymous said...

very very helpful

anil bhattarai said...

Awesome. God bless u..!!

Anonymous said...

This is a great summary. Thank you

Anonymous said...

gr8 collectn of photos

Anonymous said...

thank you

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