Figure 20-13 Pseudopolycoria that is secondary to Axenfeld-Rieger syndrome. (Courtesy of John W. Simon, MD.)

Acquired Corneal Conditions

Keratitis

Keratitis may be epithelial, stromal, peripheral, or, in rare cases, endothelial.

Infectious causes

Congenital syphilis Interstitial keratitis may occur in the first decade of life secondary to congenital syphilis. The keratitis presents as a rapidly progressive corneal edema followed by abnormal vascularization in the deep stroma adjacent to Descemet membrane. Intense vascularization may give the cornea a salmon-pink color—hence the term salmon patch. Blood flow through these vessels gradually ceases over several weeks to several months, leaving empty “ghost” vessels in the corneal stroma. Immune-mediated uveitis, arthritis, and hearing loss may also develop and recur even after treatment of syphilis. Immunosuppression may be necessary to diminish sequelae. See also Chapter 28.

Herpes simplex infection Eye involvement in congenital HSV infection can include conjunctivitis, keratitis, retinochoroiditis, and cataracts. Congenital HSV infection is discussed in Chapter 28.