Terrien's degeneration Pesudovs Figure 1. Case one, left eye showing superior temporal Figure 2. Case two, left eye showing TMD changes includ- degenerative changes typical of TMD. Note the specular ing obvious opacification and vascularisation in the inferior reflection from within the corneal gutter. nasal cornea. were unsuccessful. The general medical corneal thinning with gutter formation, than the central cornea. Unfortunately, history was unremarkable but the peripheral corneal opacification and the topographical changes occurring at immediate family history included vascularisation (Figure 2). The gutter the limbus are beyond the analytical conjunctival malignant melanoma. sloped gently from the limbal side, but powers of the Eyesis CAS. Careful The patient had been examined two rose sharply on the clear corneal side observation of the polaroid Eyesis years earlier and bifocals had been (Figure 3). These changes were along photograph of the left cornea (Figure prescribed. Vision with the bifocals was the inferior-nasal corneal margin of 6), shows gross distortion at the limbus R 6/7.5 and L 6/9. This improved to both eyes and the temporal corneal including flattening into the peripheral R 6/6 and L 6/6 with pinhole and margin of the left eye, affecting one- gutter and steepening over the spectacle correction. The axes of quarter to one-third of the corneal pseudopterygium. astigmatism rotated towards the vertical circumference in total. This peripheral New multifocals were prescribed to in both eyes with an increase in the degeneration was bilateral, although alleviate the patient's visual problems. strength of against-the-rule cylinder. much more extensive in the left eye and Tear supplements were recommended Keratometer mires and retinoscopy did not stain with fluorescein. A to reduce epiphora by preventing reflexes were both regular. Pupils and pseudopterygium was present at the dryness, but these were of only limited binocular vision findings were normal eight o'clock position in the left eye benefit. The patient was advised of the and intra-ocular pressures were within (Figure 4). Tear break-up times in both presence of Terrien's marginal normal limits. The anterior chambers eyes were of the order of three seconds degeneration and counselled in the and lenses were normal. Both fundi with all the puneta open and in prognosis, including a future role for showed old myopic degenerative apposition to the globe. RGP contact lenses to correct irregular changes. Computerised comeal topographic astigmatism and the possible need for Slit-lamp examination two years prior analysis was performed using the surgical repair. was unremarkable except for a corneal Eyesis corneal analysis system (CAS). The patient was advised to present for arcus which was unusually prominent Both eyes demonstrated regular with- review in 12 months, or sooner if vision for a 54-year-old without the-rule astigmatism on a flat cornea became unacceptable or other hyperlipoproteinaemia. At this visit, slit (Figure 5). Interestingly, the periphery symptoms such as pain or redness lamp examination revealed peripheral of both corneae was two to three developed. dioptres flatter 98 CLINICAL & EXPERIMENTAL OPTOMETRY 77. 3; 1994 MAY/JUNE Terrien's degeneration Pesudovs 3a 3b Figure 3a. The peripheral corneal gutter from case two in section. Photograph of gutter showing the gentle slope Figure 4. Pseudopterygium from the LE of case two. Note the from the limbus and the sharp rise to the central cornea. broad, flat head and the oblique angle of insertion. Figure 3b. The peripheral corneal gutter from case two in section. Diagmmmatic representation of the photograph in 3a. Figure 5. Computerised corneal topographical analysis (Eyesis) of both eyes of case two. Note the regularity of the astigmatism in the central corneae. Note also the excessive flattening in the far periphery. CLINICAL & EXPERIMENTAL OPTOMETRY 77. 3; 1994 MAY/JUNE 99 .