Unusual cases of Salzmann nodular degeneration in the pediatric age group

Salzmann nodular degeneration (SND) is an uncommon, noninflammatory, slowly progressive corneal degeneration that commonly affects the 50–60 years of age group and mostly in female patients. The presentation of SND is very rare in the pediatric age group. Although SND presentation is very rare in the pediatric age group, our SND cases presented much earlier in life in the pediatric age group. Two female children, brought by their respective parents to our hospital, presented with a diminution of vision in both eyes since birth. A 9-year-old female child presented with best-corrected visual acuity (BCVA) of 20/60 in the right eye and 20/40 in the left eye. Hirschberg corneal reflex test showed 30° left exotropia (LXT). Modified Krimsky was 45–50 prism diopters LXT. The slit-lamp examination of both eyes showed 2–3 central, round, whitish subepithelial lesions over the cornea. The rest of the anterior and posterior segments were normal. Another 11-year-old female child presented with BCVA of 20/40 in the right eye and 20/50 in the left eye. Hirschberg corneal reflex test showed 30° LXT. Slit-lamp evaluation showed inferocentral 2–3, round, whitish subepithelial lesions in the cornea. Both were sent for cornea consultation, where a clinical impression of both eyes’ SND was made. Both were given lubricants and kept under observation, and superficial keratectomy was advised if vision deteriorates or the patient is symptomatic. Here we report two cases with unusual presentation of SND in the pediatric age group.