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Cornea & External Diseases























Munson's Sign

  • Non-inflammatory, ectatic corneal disease.
  • Clinical features:
    • Symptoms:
      • Painless or may become painful in acute corneal hydrops
      • Decreased corneal sensation
      • Decreased vision
      • Distorted vision due to irregular astigmatism, corneal scarring or corneal edema
      • Photophobia
    • Signs:
      • Bilateral, progressive abnormal thinning of either the central or paracentral inferior corneal stroma
      • Onset usually during puberty
      • Munson's sign: a V-shaped dent of the lower lid produced by the conic cornea in downgaze
      • Rizutti's sign: conical reflection on the nasal cornea if light is shined from temporal side
      • Fleischer's ring: a partial or complete iron deposition ring in deep epithelium
      • Vertical Vogt's striae may be evident in deep stroma of the apex of the cone
      • Descemet's membrane rupture may result in acute hydrops with stromal or epithelial edema and subsequent subepithelial central scarring
      • Distortion of the corneal image on keratometry, retinoscopy, keratoscopy, and computerized corneal topography
  • May be associated with a variety of ocular and systemic diseases such as habitual eye rubbing, atopic dermatitis, Down's syndrome, Marfan's syndrome, osteogenesis imperfecta or Ehlers-Danlos syndrome.
  • Management:
    • Astigmatic spectacle or rigid contact lens correction.
    • Superficial keratectomy or epikeratoplasty may be attempted.
    • Penetrating keratoplasty for advanced cases.
    • Recent development: intrastromal corneal ring implant.

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