CASE REPORT
Case of Crocodile Shagreen a 67-years-old female with a past medical history significant for Type II diabetes mellitus presented with a blurry vision of 6 months onset that is worse at distance. She also complained of glare at night and difficulty with oncoming headlights while driving.
Her BCVA is 20/50 in her right eye and 20/60 in her left eye; her BAT is 20/70 and 20/80 in her right and left eye. On exam, her cataracts were graded as 2+ NS (nuclear sclerotic) and 2+ cortical spoking OU.
Her cornea also demonstrated a polygonal pattern of opacities in the posterior stroma with clear intervening spaces, resembling a “crocodile skin.”
The clinician did not feel her visual complaints were related to the corneal findings revealed on the exam and the findings were documented as crocodile shagreen.
DISEASE of Crocodile Shagreen
Crocodile shagreen classically appears as bilateral, symmetric, polygonal opacities within the central posterior corneal stroma. The opacities have indistinct edges with intervening clear spaces. The pattern closely resembles “crocodile skin.”
It is most commonly associated with advanced age. It may be seen in association with band keratopathy or after traumatic corneal injury. Isolated cases have been reported in pseudoxanthoma elasticum, glaucoma, and polymorphic amyloid degeneration.
MANAGEMENT of Crocodile Shagreen
This condition is not believed to cause reduced vision. No treatment is necessary.
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REFERENCES
- American Academy of Ophthalmology. Crocodile shagreen.
- Belliveau, Brownstein, Agapitos, Font. Ultrastructural Features of Posterior Crocodile Shagreen of the Cornea. Survery of Ophthalmology 2009; 54 (5); 569-575.2. Tripathi RC and Bron AJ. British Journal of Ophthalmology 1975; 59; 59.
- Krachmer, CORNEA, Second edition, 2005, Volume One, p 999.
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