Scott Burk, MD/PhD
Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA

Fig. 1

Fig. 2

Figure 1-2: Anterior segment photographs of 2 different individuals.

1. What is your diagnosis?
   
2. What are the symptoms?
   
3. What is the typical presentation for this condition?
   
4. What is the pathophysiology of this condition?
   
5. What is the inheritance pattern of this condition?
   
6. What treatment would you recommend?
   

RISPOSTE

1. What is your diagnosis?
   Answer: Meesmann's corneal dystrophy.

    

2. What are the symptoms?
   Answer: The symptoms are generally limited to a slight decrease in visual acuity, and mild surface irritation.

    

3. What is the typical presentation for this condition?
   Answer: The disease may be diagnosed in the first years of life clinically as tiny epithelial vesicles generally extending to the limbus, best seen in retroillumination.

    

4. What is the pathophysiology of this condition?
   Answer: The epithelial cells contain a "peculiar substance" of unknown composition.

    

5. What is the inheritance pattern of this condition?
   Answer: Autosomal dominant.

    

6. What treatment would you recommend?
   Answer: Generally no treatment is required, however soft contact lenses may be helpful for symptomatic patients.