Disorder characterized by arc-shaped staining secondary to corneal splitting that leads to a full thickness epithelial lesion from 10-2 o'clock within 2-3 mm of superior limbus

Disorder characterized by arc-shaped staining secondary to corneal splitting that leads to a full thickness epithelial lesion from 10-2 o'clock within 2-3 mm of superior limbus

• A. Marginal corneal infiltrate
• B. Neurotrophic ulcer
• C. Superior epithelial arcuate lesion (SEAL)
• D. Disciform keratitis

Answer: (C)

This pattern is the hallmark of a superior epithelial arcuate lesion. It presents as an arc-shaped zone of fluorescein staining in the superior peripheral cornea, spanning roughly from 10 o’clock to 2 o’clock and staying within a couple millimeters of the superior limbus. The staining reflects a break or splitting of the surface epithelium along a curved line, creating a focused, full-thickness epithelial defect that follows the lid margin. This spatial arrangement near the superior limbus, together with the curved, arc-like appearance, distinguishes it from other conditions. A marginal corneal infiltrate shows a peripheral inflammatory infiltrate with stromal involvement and a less defined epithelial arc. A neurotrophic ulcer features irregular, non-healing epithelial defects often with reduced corneal sensation, not a clean arcuate pattern. Disciform keratitis produces a central stromal edema and a disc-shaped lesion, not an epithelial arc near the lid. So, the described arc-shaped, superior peripheral epithelial defect best fits the superior epithelial arcuate lesion.

This pattern is the hallmark of a superior epithelial arcuate lesion. It presents as an arc-shaped zone of fluorescein staining in the superior peripheral cornea, spanning roughly from 10 o’clock to 2 o’clock and staying within a couple millimeters of the superior limbus. The staining reflects a break or splitting of the surface epithelium along a curved line, creating a focused, full-thickness epithelial defect that follows the lid margin.

This spatial arrangement near the superior limbus, together with the curved, arc-like appearance, distinguishes it from other conditions. A marginal corneal infiltrate shows a peripheral inflammatory infiltrate with stromal involvement and a less defined epithelial arc. A neurotrophic ulcer features irregular, non-healing epithelial defects often with reduced corneal sensation, not a clean arcuate pattern. Disciform keratitis produces a central stromal edema and a disc-shaped lesion, not an epithelial arc near the lid.

So, the described arc-shaped, superior peripheral epithelial defect best fits the superior epithelial arcuate lesion.