Research

Epithelial Downgrowth

AAO Journal1d ago1 min read

A 65-year-old woman presented with an amelanotic mass in the anterior chamber of the right eye, 25 years after penetrating trauma. Visual acuity was light perception in the right eye. Slit-lamp examination showed an inferonasal corneal scar and a lobulated pearly-white lesion arising from the nasal aspect (A). Anterior-segment OCT revealed a cystic lesion with a hyperreflective anterior wall touching the corneal endothelium, plus a healed corneal laceration (B, ∗) and a fistulous tract connecting to the cyst (C, arrow), embedded in the stroma.

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AI Summary

Quick Take

A 65-year-old woman presented with a pearly-white amelanotic mass in the anterior chamber 25 years after a penetrating injury, resulting in light perception vision. Anterior-segment OCT confirmed a diagnosis of epithelial downgrowth, identifying a cystic lesion with a hyperreflective wall and a fistulous tract connecting the cyst to a healed corneal laceration.

Why It Matters

Epithelial downgrowth is a rare but devastating complication of ocular surgery or trauma where surface epithelium migrates into the eye, often leading to secondary glaucoma or corneal decompensation. This case highlights the extreme latency that can occur, with symptoms manifesting decades after the initial insult. Recognizing the characteristic pearly appearance and using AS-OCT to identify fistulous tracts is crucial for differentiating these lesions from other anterior chamber masses, such as iris tumors or inflammatory nodules, which require vastly different management strategies.

Key Findings

Visual acuity in the affected right eye was limited to light perception at the time of presentation.
Slit-lamp examination revealed a lobulated, pearly-white amelanotic lesion arising from the nasal aspect of the anterior chamber near an inferonasal corneal scar.
Anterior-segment OCT (AS-OCT) identified a cystic lesion with a hyperreflective anterior wall in direct contact with the corneal endothelium.
Imaging confirmed a healed corneal laceration and a specific fistulous tract embedded in the stroma that connected the external environment to the internal cyst.

Practice Implications

Clinicians should maintain a high index of suspicion for epithelial downgrowth in patients with a history of penetrating trauma or intraocular surgery, regardless of how much time has passed. AS-OCT should be utilized as a primary non-invasive tool to visualize the internal architecture of anterior chamber masses and to identify the entry point or fistulous tract, which is essential for definitive diagnosis and surgical planning.

Who's Affected

OphthalmologistsCornea SpecialistsAnterior Segment SurgeonsOptometrists

Evidence StrengthPreliminary

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