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Salzmann Nodular Degeneration

Graue-Hernández, Enrique O MD; Mannis, Mark J MD; Eliasieh, Kasra MD; Greasby, Tamara A MS; Beckett, Laurel A PhD; Bradley, Jay C MD; Schwab, Ivan R MD

doi: 10.1097/ICO.0b013e3181b7658d
Clinical Science

Purpose: To describe the characteristic, clinical, and epidemiological features of Salzmann nodular degeneration.

Methods: Retrospective review of cases. All patients with diagnosis of Salzmann nodular degeneration examined on the Cornea and External Disease Service in the Department of Ophthalmology and Vision Science at the University of California, Davis, were included in this review. Demographic features, clinical characteristics, treatment regimens, surgical procedures, and outcomes were recorded. Descriptive statistics, correlation statistics in bilateral cases, and simple regression models were constructed to assess the effect of potential indicators of severity.

Results: One hundred eighty eyes of 108 patients were included in this review. Seventy-nine patients (72.2%) were female and 29 (27.8%) were male. Seventy-two patients had bilateral disease. The mean age for all patients was 60.8 (13-92) years, and the mean follow-up time was 61.2 months (0-357 months). 76.1% of all eyes were from White. Mean logarithm of the minimum angle of resolution best-corrected visual acuity was 0.24 (Snellen equivalent 20/35, range −0.12 to 2.60, SD 0.44). Decreased visual acuity was the most common symptom in 30.6% of patients. The visual axis was affected in 30% of the cases. Meibomian gland dysfunction was the most common coexistent condition, identified in 41.7% of the cases. For bilateral cases, Spearman correlations for best-corrected visual acuity, magnitude of astigmatism, spherical equivalent, and disease extension were statistically significant (P = 0.001). The number of quadrants affected was found to be a significant predictor for astigmatism (P = 0.01). Surgery was indicated in 41 eyes of 30 patients. Decreased visual acuity was the most common indication for superficial keratectomy. Patients with more than 1 quadrant of the cornea affected or those in which the central visual axis was involved were more likely to require surgery (P = 0.015 and 0.0001, respectively). The surgical outcome was satisfactory in 90.2% of the cases; 9 eyes (21.9%) developed recurrences.

Conclusions: Salzmann nodular degeneration is a disease of uncertain etiology in which inflammation of the ocular surface may play a role. It predominantly affects women in the sixth decade of life. Management with conservative therapy is generally adequate, and in cases that require surgical intervention, simple nodulectomy is usually effective.

From the *Department of Ophthalmology and Vision Science, UC Davis Health System Eye Center; and †Department of Public Health Sciences, University of California, Davis, Davis, CA.

Received for publication December 29, 2008; revision received July 5, 2009; accepted July 8, 2009.

Supported in part by a grant from Research to Prevent Blindness, Inc, New York, NY. Statistical support made possible by grant number UL1 RR024145 from National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and National Institutes of Health roadmap for Medical Research.

The contents are solely the responsibility of the authors and do not necessarily represent the official view of National Center for Research Resources or National Institute of Health.

Reprints: Mark J. Mannis, MD, Department of Ophthalmology and Vision Science, 4860 Y St, Suite 2400, Sacramento, CA 95817 (e-mail:

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