Case Report – Bilateral Manifestation of Terrien’s Marginal Degeneration

Abstract

Purpose: To report our findings in a case of asymmetrically bilateral Terrien’s marginal degeneration (TMD) involving the left eye more than the right eye.
Observations: A 35-yr old male visited our OPD with a complaint of diminution of vision in the left eye. He had a history of pterygium surgery in the left eye 20 days back elsewhere. There was no improvement in visual acuity of the left eye with best correction. Slit lamp examination showed bilateral peripheral corneal thinning with neovascularization and central macular grade corneal opacities in the left eye. Corneal topography showed ectatic areas on anterior and posterior elevation map, areas of high-risk corneal thinning on pachymetry in the left eye, high Kmax values in both eyes despite normal corneal pachymetry in the right eye, indicating progression of disease in the right eye as well. Based on slit lamp examination, results of corneal topography, AS-OCT and lipid profile, we diagnosed him as a case of bilateral Terrien’s marginal degeneration involving the left eye more than the right eye. The patient is otherwise asymptomatic and was started on lubricants in both eyes with close follow-up.
Conclusion: We found a rare presentation of an early asymmetrically bilateral TMD associated with a history of pterygium. Corneal topography along with slit lamp examination and increased lipid profile levels helped in diagnosing the case as TMD while ruling out other close differentials of the disease like Pellucid marginal degeneration and Keratoconus.