ACTA OPHTHALMOLOGICA VOL. 4 3 1 9 6 5

From the A . M. U. Institute of Ophthalmology, Gandhi Eye Hospital - Aligarh

PRE-CORNEAL MEMBRANE*)

[Corneal Ve i l )

BY

H . V . Nema, K . Nath SC H . Saiduzzafar

Precorneal membrane consists of a flattened epithelialised fibrovascular fold running in front of the cornea, forming a sort of veil under which a probe can be passed, I t leads to gross visual impairment but the recovery is complete fol- lowing its excision. Except for a case reported by Singh and Grover (1960), no other reference could be found in the literature. Recently two more cases were seen and investigated by us whose veils were excised and histopathologically examined. They are being reported herewith.

C A S E REPORTS

Case 1: A Muslim child, resident of Needru (Dt. Bijnor), aged ll /z , was brought to Gandhi Eye Hospital, Aligarh, on May 5 , 1963 with the complaint of a fleshy growth in the left eye for 20 days, following an attack of redness in both eyes, a month before. The village doctor treated the child by local caustic applications which resulted in ag- gravation of the swellings of the lids and the child could not open the eyes. After 5 days when the child opened the eyes, after regression of the swelling, a fleshy growth connecting the two lids was noticed in the left eye.

Examination: On separation of the two lids, a trapezoid membrane, with its narrower end attached to the conjunctiva of the upper lid, 3 mm. above the posterior lid margin and the broader end continuous with the lower fornix, was seen (fig. 1). The visible palpebral conjunctiva and the membrane were both inflammed and a probe could be passed horizontally between the cornea and the band. There was slight collection of mucopurulent discharge a t the angles of the left eye.

Investigations: Left eye culture showed the presence of Staphylococcus aureus and Streptococcus viridans. Blood showed a leucocytosis of 13,810/c.mm. with slight increase in eosinophils (9 O/o). Urine was normal.

”) Received July 30th 1964.

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Fig. 1. (Case 1) L. E. Precorneal membrane connecting the upper palpebral conjunctiva and the lower fornix. A probe could be easily passed between the membrane and the cornea.

Fig. 2. (Case 1) The same case as in Figure 1 after the excision

of the precorneal membrane.

TTeatment and Histopathology: The patient was kept on local antibiotics and when the local inflammation subsided, the membrane was excised on May 22, 19F3 under general anaesthesia (Fig. 2) and sent for histopathological examination. Microscopic examination revealed that i t was lined by transitional epithelium, 8-10 layer thick. The basal layer had slight black pigmentation. The subepithelial zone and thin parenchyma showed aggragation of chronic inflammatory cells with fibrobfastic activity and neo- vascularization. At places the epithelium was inveginated (fig. 3). The picture was that of organising granulation tissue.

Cose 2: A local Muslim infant, of 8 months, with a history of sore eyes for 10 days was examined on August 23, 1963 at the same hospital. His conjunctiva was scraped and silver nitrate application was made by a quack 6 days ago.

Exominat ion: In left eye a flat rectangular precorneal tissue, with its upper edge at-

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Fig. 3. Showing the histopathology of the precorneal membrane. The section is lined by

transitional epithelium and shows chronic inflammatory reaction.

Fig. 4. (Case 2) L. E. Precorneal membrane lifted by the handle of the forceps.

tached to the upper posterior lid margin and the lower edge continuous with the palpe- bra1 conjunctiva of lower lid, 2 mm below the posterior lid margin, was seen. On pulling the lids apart, the membrane could be stretched and lifted from the cornea (fig. 4). This membrane was quite smooth except for few scattered white spots of or- ganised exudate.

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Fig. 5. (Case 2) L. E. After excision of the membrane

Investigations and treatment: Left eye culture showed Diplococcus pneumonae and blood showed a leucocytosis of 18500/c.mm. with 7 Z n / o polys. The membrane was ex- cised on October 10, 1963 (fig. 5 ) under general anaesthesia, the gap was repaired and the tissue was sent for histopathology which revealed a similar picture as in case I.

DISCUSSlON

Precorneal membrane is a rare type of accessory conjunctival fold. Like other folds its etiology is also inflammatory in origin. Scraping in the acute stage of conjunctivitis or indescriminate use of caustics are contributing factors in its causation. If raw areas in the upper and lower palpebral conjunctiva are created and eye remains closed for a considerable period (2-3 days), it leads to their adhesion along with the growth of fibrovascular tissue. This tissue gets stretched on repeated attempted blinking and assumes the shape of a precorneal membrane. Often, the membrane does not adhere with cornea and therefore, it has a good operative visual prognosis as is evident from the foregoing cases. Any delay in the excision of the membrane may result in gross visual defect because such eyes are predisposed to subsequent attacks of conjunctivitis as the mem- brane harbours microorganisms. A liberal use of sulphonamides and antibiotics and avoidence of caustics in acute conjunctivitis may prevent the formation of the membrane.

REFERENCE

Singh, S . and Grover, A. D.: (1960) A. M. A. Arch. Ophthal., 63: 503.

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