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| PHOTO ESSAY |
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| Year : 2023 | Volume
: 3
| Issue : 1 | Page : 184 |
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Spontaneous dellen formation in setting of Parkinson's disease
Alex L Song, Jennifer Park
Department of Ophthalmology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| Date of Submission | 30-May-2022 |
| Date of Acceptance | 21-Sep-2022 |
| Date of Web Publication | 20-Jan-2023 |
Correspondence Address:
Jennifer Park
Department of Ophthalmology, SUNY Downstate Health Sciences University, 450 Clarkson Ave., Room B7-302, MSC 58 Brooklyn, NY 11203
USA
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ijo.IJO_1344_22
Keywords: Cornea, dellen, neurotrophic keratopathy, Parkinson's disease
How to cite this article:
Song AL, Park J. Spontaneous dellen formation in setting of Parkinson's disease. Indian J Ophthalmol Case Rep 2023;3:184 |
A 75-year-old woman with Stage 4 Parkinson's disease was referred for “corneal melt” in the right eye. On presentation, distance uncorrected visual acuity was counting fingers at 1 foot in the right eye, which was her baseline. The ophthalmologic evaluation revealed moderate meibomian gland dysfunction, decreased tear break-up time, incomplete blink, and infrequent blink rate (around four blinks per minute). Her conjunctiva was mildly injected without chemosis or areas of conjunctival elevation. She had an area of saucer-shaped corneal thinning at the limbus without an overlying epithelial defect from 3 to 4 o'clock in the right eye [Figure 1]. The cornea was approximately 20% of normal thickness. Given the morphology of the corneal thinning and her risk factors, dellen was the highest on the differential.[1],[2] Because the patient presented on a Friday afternoon, cyanoacrylate corneal glue and a bandage contact lens (BCL) were placed over the area of thinning as a precaution. She was also started on hourly preservative-free artificial tears. When the BCL was removed after 7 weeks, the cornea in the area was restored to normal thickness without any residual thinning, confirming the diagnosis of dellen [Figure 2]. | Figure 1: Slit-lamp photo of the right eye at initial presentation. There is a clearly defined depressed region on the nasal cornea with a steep corneal edge and sloping limbal edge without an overlying epithelial defect
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 | Figure 2: Slit-lamp photo of the right eye at her week 7 visit. The cornea in the area of initial concern has returned to full thickness
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| Discussion | |  |
Currently, there is a lack of published literature that directly links dellen to Parkinson's disease although Parkinson's disease itself has been described to be a potential cause of evaporative dry eye disease.[3] Studies have shown that dopamine depletion affects the eye in many ways, including a reduction in spontaneous blinking, seborrheic blepharitis, keratoconjunctivitis sicca, and cataract formation.[4] Therefore, we hypothesize that the patient developed a spontaneous dellen due to a combination of the aforementioned factors. Most patients heal within several days with frequent lubrication, BCL, and/or patching of the eye. If the adjacent conjunctival elevation is present, its cause should also be addressed to improve precorneal tear film stability.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Fuchs A. Pathological dimples (“Dellen”) of the cornea. Am J Ophthalmol 1929;12:877-83.  |
| 2. | Accorinti M, Gilardi M, Giubilei M, De Geronimo D, Iannetti L. Corneal and scleral dellen after an uneventful pterygium surgery and a febrile episode. Case Rep Ophthalmol 2014;5:111-5. |
| 3. | Bron AJ. The Doyne Lecture.Reflections on the tears. Eye (Lond) 1997;11:583-602. |
| 4. | Borm CDJM, Visser F, Werkmann M, de Graaf D, Putz D, Seppi K, et al. Seeing ophthalmologic problems in Parkinson disease: Results of a visual impairment questionnaire. Neurology 2020;94:e1539-47. |
[Figure 1], [Figure 2]
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